MEDICARE: CYNTHIA K OLSEN AUDIOLOGIST

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	231H00000X	Audiologist	AU1204	ID

General Provider Information

NPI Number	:	1588732325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA K OLSEN AUDIOLOGIST

Provider Business Mailing Address
First Line	:	1740 N. MILWAUKEE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704
Country	:	US
Telephone Number	:	208-658-0328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 N. MILWAUKEE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704
Country	:	US
Telephone Number	:	208-658-0328
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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