Provider Demographics
NPI:1942827035
Name:LOWERY, OLIVIA H (CF-SLP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:H
Last Name:LOWERY
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:A
Other - Last Name:HARRIS-BLOOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 KENYON ST NW APT G4
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2770
Mailing Address - Country:US
Mailing Address - Phone:707-888-0668
Mailing Address - Fax:
Practice Address - Street 1:1400 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3711
Practice Address - Country:US
Practice Address - Phone:360-895-5000
Practice Address - Fax:877-516-9023
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA390200000X
WALL61178855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program