Healthcare Provider Details

I. General information

NPI: 1023949286
Provider Name (Legal Business Name): LILLIAN OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CARRIE ST
WEST SACRAMENTO CA
95605-2046
US

IV. Provider business mailing address

3416 AMERICAN RIVER DR STE B
SACRAMENTO CA
95864-5753
US

V. Phone/Fax

Practice location:
  • Phone: 916-375-7700
  • Fax:
Mailing address:
  • Phone: 916-979-0497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSPA8522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: