Healthcare Provider Details

I. General information

NPI: 1598724627
Provider Name (Legal Business Name): JILL FARRIS OLEKSIAK M.A., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST
MEDINA OH
44256-2170
US

IV. Provider business mailing address

241 RYELAND CIR
MEDINA OH
44256-2143
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-1000
  • Fax:
Mailing address:
  • Phone: 330-722-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: