Provider Demographics
NPI:1669411716
Name:PERKINS, OLGA VON HARTZE
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:VON HARTZE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:VON HARTZE
Other - Last Name:WAGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:12381 S CLEVELAND AVE STE 405
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3893
Practice Address - Country:US
Practice Address - Phone:239-461-9321
Practice Address - Fax:239-461-5354
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5494237700000X
MD02453237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist