Provider Demographics
NPI:1598762783
Name:OLSEN, ROBERT G (AU D)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:G
Last Name:OLSEN
Suffix:
Gender:M
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 E FLAMINGO RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5069
Mailing Address - Country:US
Mailing Address - Phone:702-898-5700
Mailing Address - Fax:702-898-5900
Practice Address - Street 1:3530 E FLAMINGO RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5069
Practice Address - Country:US
Practice Address - Phone:702-898-5700
Practice Address - Fax:702-898-5900
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA55231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNKBBBMedicare ID - Type Unspecified
R09712Medicare UPIN