Healthcare Provider Details

I. General information

NPI: 1043598972
Provider Name (Legal Business Name): RYAN OLMSTEAD SLPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 S HIGLEY RD
MESA AZ
85206-2148
US

IV. Provider business mailing address

551 S HIGLEY RD
MESA AZ
85206-2148
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-9777
  • Fax: 480-635-0222
Mailing address:
  • Phone: 480-892-9777
  • Fax: 480-635-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA7378
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: