Provider Demographics
NPI:1821326935
Name:OLDS, KATHLYN ELIZABETH (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHLYN
Middle Name:ELIZABETH
Last Name:OLDS
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 RALEIGH PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-8546
Mailing Address - Country:US
Mailing Address - Phone:440-510-8047
Mailing Address - Fax:
Practice Address - Street 1:35300 KAISER CT
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-6633
Practice Address - Country:US
Practice Address - Phone:440-510-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9270235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist