Provider Demographics
NPI:1205666146
Name:OLIVE SPEECH & LANGUAGE THERAPY, P.C.
Entity type:Organization
Organization Name:OLIVE SPEECH & LANGUAGE THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-922-9453
Mailing Address - Street 1:549 W BOBIER DR APT 205
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-1821
Mailing Address - Country:US
Mailing Address - Phone:619-922-9453
Mailing Address - Fax:
Practice Address - Street 1:549 W BOBIER DR APT 205
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-1821
Practice Address - Country:US
Practice Address - Phone:619-922-9453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty