Healthcare Provider Details

I. General information

NPI: 1649551581
Provider Name (Legal Business Name): LARA ANN OLNEY M.A.,CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 GRAY RD
PENN YAN NY
14527-9554
US

IV. Provider business mailing address

2821 GRAY RD
PENN YAN NY
14527-9554
US

V. Phone/Fax

Practice location:
  • Phone: 607-329-6780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number021217-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: