Provider Demographics
NPI:1710187208
Name:OLIVE, LAURIE JEAN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:JEAN
Last Name:OLIVE
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 1:20581 TORRE DEL LAGO ST
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6351
Mailing Address - Country:US
Mailing Address - Phone:239-992-2065
Mailing Address - Fax:
Practice Address - Street 1:20581 TORRE DEL LAGO ST
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6351
Practice Address - Country:US
Practice Address - Phone:239-992-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7265235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist