Provider Demographics
NPI:1750477519
Name:OLSON, KATHERINE G (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:G
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 1:1919 OAKWELL FARMS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1726
Mailing Address - Country:US
Mailing Address - Phone:210-857-7757
Mailing Address - Fax:210-821-3727
Practice Address - Street 1:1919 OAKWELL FARMS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-1726
Practice Address - Country:US
Practice Address - Phone:210-857-7757
Practice Address - Fax:210-821-3727
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101383235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181722301Medicaid