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NPI 1740553601

NPI 1740553601 : HEIDI A OLSON SLP : COEUR D ALENE, ID

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General NPI Number Information
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    NPI Number           |    1740553601
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    Entity Type          |    Individual 
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    Provider Name        |    HEIDI A OLSON SLP
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    02/22/2012
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    Last Update Date     |    07/25/2024
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Provider Practice Location Address
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    Address Line         |    1250 W IRONWOOD DR STE 241 
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    City                 |    COEUR D ALENE
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    State                |    ID
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    Zip                  |    83814-2682
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    Country              |    US
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    Telephone            |    208-419-3575
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    1250 W IRONWOOD DR STE 241 
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    City                 |    COEUR D ALENE
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    State                |    ID
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    Zip                  |    83814-2682
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    Country              |    US
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    Telephone            |    208-419-3575
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    235Z00000X
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    Taxonomy Name        |    Speech-Language Pathologist
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    License Number       |    LL00004303
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    License Number State |    WA
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Taxonomy #2
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    Taxonomy Code        |    235Z00000X
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    Taxonomy Name        |    Speech-Language Pathologist
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    License Number       |    SLP-5394
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    License Number State |    ID
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