Healthcare Provider Details

I. General information

NPI: 1063322394
Provider Name (Legal Business Name): OLIVIA ANN BLACKER SLP-ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA ANN MADSEN

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12708 RIATA VISTA CIR STE A106
AUSTIN TX
78727-7174
US

IV. Provider business mailing address

12708 RIATA VISTA CIR STE A106
AUSTIN TX
78727-7174
US

V. Phone/Fax

Practice location:
  • Phone: 737-265-7471
  • Fax:
Mailing address:
  • Phone: 737-265-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number45535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: