Healthcare Provider Details

I. General information

NPI: 1457124000
Provider Name (Legal Business Name): OLIVIA KIRCHNER M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA GRAHAM M.A., CCC-SLP

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 N RIVER RD
MUNROE FALLS OH
44262-1315
US

IV. Provider business mailing address

380 N RIVER RD
MUNROE FALLS OH
44262-1315
US

V. Phone/Fax

Practice location:
  • Phone: 330-689-5288
  • Fax:
Mailing address:
  • Phone: 330-689-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.15698
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: