Provider Demographics
NPI:1508330168
Name:OLSON, BROOKE A (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:OLSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2835 W SAINT GERMAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-6280
Mailing Address - Country:US
Mailing Address - Phone:320-259-4151
Mailing Address - Fax:
Practice Address - Street 1:2835 W SAINT GERMAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-6280
Practice Address - Country:US
Practice Address - Phone:320-259-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist