Provider Demographics
NPI:1336746809
Name:OLSON, KAREN M (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4506 N ASHLAND AVE APT 1S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5445
Mailing Address - Country:US
Mailing Address - Phone:586-260-5823
Mailing Address - Fax:
Practice Address - Street 1:4506 N ASHLAND AVE APT 1S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5445
Practice Address - Country:US
Practice Address - Phone:586-260-5823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012786235Z00000X
IL1116985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist