MEDICARE: TARA OLSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	146014009	IL
2	235Z00000X	Speech-Language Pathologist	15736	OR

General Provider Information

NPI Number	:	1205358900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA OLSEN

Provider Business Mailing Address
First Line	:	4610 N CLARK ST # 1285
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4620
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 N MICHIGAN AVE STE 208
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-7940
Country	:	US
Telephone Number	:	312-600-3790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2017
Last Update Date	:	03/19/2026

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Directions to “ TARA OLSEN ” Practice Location

Language	Start Address	Practice Location

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