Provider Demographics
NPI:1154878916
Name:GINN, OLIVIA LILLIAN (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:LILLIAN
Last Name:GINN
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 1:6732 WINDING CEDAR TRL
Mailing Address - Street 2:APT 205
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-8233
Mailing Address - Country:US
Mailing Address - Phone:262-210-4934
Mailing Address - Fax:
Practice Address - Street 1:6732 WINDING CEDAR TRL
Practice Address - Street 2:APT 205
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8233
Practice Address - Country:US
Practice Address - Phone:262-210-4934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11439235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist