Provider Demographics
NPI:1356543409
Name:OLMSTEAD, PATRICIA J (MCSD)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:J
Last Name:OLMSTEAD
Suffix:
Gender:F
Credentials:MCSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 110175
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0175
Mailing Address - Country:US
Mailing Address - Phone:907-222-2452
Mailing Address - Fax:907-222-2452
Practice Address - Street 1:16441 CHASEWOOD LN
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-4860
Practice Address - Country:US
Practice Address - Phone:907-222-2452
Practice Address - Fax:907-222-2452
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP0707Medicaid