Provider Demographics
NPI:1851680276
Name:OLGES, KATHLEEN L (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:L
Last Name:OLGES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 S WESTERN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-1875
Mailing Address - Country:US
Mailing Address - Phone:812-339-3714
Mailing Address - Fax:
Practice Address - Street 1:736 S WESTERN DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-1875
Practice Address - Country:US
Practice Address - Phone:812-339-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001095A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist