Healthcare Provider Details

I. General information

NPI: 1518410810
Provider Name (Legal Business Name): ALISON M OLIVO AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON M KIOLBASA

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR STE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-0480
  • Fax:
Mailing address:
  • Phone: 314-996-4192
  • Fax: 314-996-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2016023476
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001623
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: