Healthcare Provider Details

I. General information

NPI: 1982953683
Provider Name (Legal Business Name): SHEILA M OLOFFSSON M.S., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 W 102 ST
CHICAGO IL
60643-2025
US

IV. Provider business mailing address

1928 W 102 ST
CHICAGO IL
60643-2025
US

V. Phone/Fax

Practice location:
  • Phone: 773-779-8442
  • Fax: 773-779-7298
Mailing address:
  • Phone: 773-779-8442
  • Fax: 773-779-7298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147000303
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: