Provider Demographics
NPI:1265574404
Name:OLSON, JUDITH MARQUESS (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:MARQUESS
Last Name:OLSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:DR
Other - First Name:JUDITH
Other - Middle Name:MARQUESS
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 W NAVAJO ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1940
Mailing Address - Country:US
Mailing Address - Phone:765-771-7109
Mailing Address - Fax:765-770-8668
Practice Address - Street 1:750 PARK EAST BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905
Practice Address - Country:US
Practice Address - Phone:765-771-7109
Practice Address - Fax:765-770-8668
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 1981231H00000X, 237600000X
IN23002471A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200984380Medicaid
IN200984380Medicaid
IN000000663747OtherANTHEM PROVIDER NUMBER
CAZZZ31195ZMedicare ID - Type UnspecifiedPROVIDER NUMBER
INM400016384Medicare PIN