Healthcare Provider Details

I. General information

NPI: 1437070992
Provider Name (Legal Business Name): CORINNA OLSEN M.S., CCC-SLP/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14621 HARDING AVE
MIDLOTHIAN IL
60445-2847
US

IV. Provider business mailing address

8305 S 77TH CT
BRIDGEVIEW IL
60455-1742
US

V. Phone/Fax

Practice location:
  • Phone: 708-388-4121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146.018882
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: