Provider Demographics
NPI:1932416955
Name:ISMAILOV, OLGA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:ISMAILOV
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188-45 71 CRESCENT
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2607
Mailing Address - Country:US
Mailing Address - Phone:347-456-5483
Mailing Address - Fax:
Practice Address - Street 1:188-45 71 CRESCENT
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2607
Practice Address - Country:US
Practice Address - Phone:347-456-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist