Provider Demographics
NPI:1013797109
Name:OLIVA, KARLEY (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARLEY
Middle Name:
Last Name:OLIVA
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 1:1 ALLEN PL
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3201
Mailing Address - Country:US
Mailing Address - Phone:631-252-9914
Mailing Address - Fax:
Practice Address - Street 1:1 ALLEN PL
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3201
Practice Address - Country:US
Practice Address - Phone:631-252-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist