Provider Demographics
NPI:1255632691
Name:OLSON, PAMELA ARNOLD (SLP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ARNOLD
Last Name:OLSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RED MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:SHOKAN
Mailing Address - State:NY
Mailing Address - Zip Code:12481-5618
Mailing Address - Country:US
Mailing Address - Phone:845-657-6742
Mailing Address - Fax:
Practice Address - Street 1:4166 ROUTE 28
Practice Address - Street 2:
Practice Address - City:BOICEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12412
Practice Address - Country:US
Practice Address - Phone:845-657-2373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003813-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist