Provider Demographics
NPI:1215498704
Name:BETULIA, OLIVIA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BETULIA
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 1:18333 E ELMENDORF DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8804
Mailing Address - Country:US
Mailing Address - Phone:718-864-6334
Mailing Address - Fax:
Practice Address - Street 1:695 S COLORADO BLVD STE 20103
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8008
Practice Address - Country:US
Practice Address - Phone:303-360-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist