Healthcare Provider Details

I. General information

NPI: 1811833817
Provider Name (Legal Business Name): AMY RENEE OLFERT MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 12TH ST N
MOUNTAIN LAKE MN
56159-1593
US

IV. Provider business mailing address

2030 COTTONWOOD LAKE DR
WINDOM MN
56101-1257
US

V. Phone/Fax

Practice location:
  • Phone: 507-427-2325
  • Fax:
Mailing address:
  • Phone: 605-777-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number472064
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: