Provider Demographics
NPI:1720232853
Name:AVIGNONE, OLYMPIA (MA, CCC-SLP, PC)
Entity Type:Individual
Prefix:MS
First Name:OLYMPIA
Middle Name:
Last Name:AVIGNONE
Suffix:
Gender:F
Credentials:MA, CCC-SLP, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-1318
Mailing Address - Country:US
Mailing Address - Phone:516-546-2906
Mailing Address - Fax:516-546-2906
Practice Address - Street 1:125 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-1318
Practice Address - Country:US
Practice Address - Phone:516-546-2906
Practice Address - Fax:516-546-2906
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001963-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist