Provider Demographics
NPI:1679843486
Name:OLIVER, JANINA LYN (SLP)
Entity Type:Individual
Prefix:MS
First Name:JANINA
Middle Name:LYN
Last Name:OLIVER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:JANINA
Other - Middle Name:LYN
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3775 S 645 E
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1147
Mailing Address - Country:US
Mailing Address - Phone:208-390-9400
Mailing Address - Fax:
Practice Address - Street 1:3775 S 645 E
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84106-1147
Practice Address - Country:US
Practice Address - Phone:208-390-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2016-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT35457-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist