Provider Demographics
NPI:1255876520
Name:FITZSIMMONS-OLSEN, ASHLEY (SLP)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:FITZSIMMONS-OLSEN
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 1:677 EAST STATE STREET
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-8777
Mailing Address - Country:US
Mailing Address - Phone:262-763-9531
Mailing Address - Fax:262-763-7579
Practice Address - Street 1:677 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53105-8777
Practice Address - Country:US
Practice Address - Phone:262-763-9531
Practice Address - Fax:262-763-7579
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4378-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist