Healthcare Provider Details

I. General information

NPI: 1871756577
Provider Name (Legal Business Name): MEGAN MARIE OLSON M.A, CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3965 75TH ST STE 104
AURORA IL
60504-7926
US

IV. Provider business mailing address

3965 75TH ST STE 104
AURORA IL
60504-7926
US

V. Phone/Fax

Practice location:
  • Phone: 630-236-7000
  • Fax: 630-236-7800
Mailing address:
  • Phone: 630-236-7000
  • Fax: 630-236-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.009064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: