Provider Demographics
NPI:1821839028
Name:GREEN, OLEANDER (AUD)
Entity type:Individual
Prefix:
First Name:OLEANDER
Middle Name:
Last Name:GREEN
Suffix:
Gender:X
Credentials:AUD
Other - Prefix:
Other - First Name:OLLY
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:3120 PEARL PKWY APT 315
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2495
Mailing Address - Country:US
Mailing Address - Phone:920-202-4666
Mailing Address - Fax:
Practice Address - Street 1:4745 ARAPAHOE AVE STE 310
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1082
Practice Address - Country:US
Practice Address - Phone:303-443-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1261231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist