Healthcare Provider Details

I. General information

NPI: 1114505971
Provider Name (Legal Business Name): OLIVIA ANN EDELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MILLER RD STE 150A
FAIRLAWN OH
44333-3713
US

IV. Provider business mailing address

3800 ROSEMONT BLVD APT 102B
FAIRLAWN OH
44333-9255
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-2240
  • Fax:
Mailing address:
  • Phone: 248-494-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20201600-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: