Provider Demographics
NPI:1497268262
Name:OLSON, KRISTEN ANN (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13513 SUMMERGROVE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2903
Mailing Address - Country:US
Mailing Address - Phone:630-639-8224
Mailing Address - Fax:
Practice Address - Street 1:67 LONGBEACH RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IL
Practice Address - Zip Code:60538-2437
Practice Address - Country:US
Practice Address - Phone:630-636-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist