Healthcare Provider Details

I. General information

NPI: 1770606766
Provider Name (Legal Business Name): CARISA NICOLE OLSON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11688 LAKE FOREST PKWY
CARMEL IN
46033-7208
US

IV. Provider business mailing address

264 SUGAR BUSH LN S
BROWNSBURG IN
46112-2000
US

V. Phone/Fax

Practice location:
  • Phone: 317-818-8166
  • Fax: 317-818-8266
Mailing address:
  • Phone: 317-748-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22003928A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: