MEDICARE: ELIZABETH BAYSA OLSON CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	22320	CA
2	235Z00000X	Speech-Language Pathologist	14113	AZ

General Provider Information

NPI Number	:	1093546186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BAYSA OLSON CCC-SLP

Provider Business Mailing Address
First Line	:	2039 W POST OAK DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-8753
Country	:	US
Telephone Number	:	928-756-2698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2039 W POST OAK DR
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-8753
Country	:	US
Telephone Number	:	805-868-5275
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2024
Last Update Date	:	08/09/2024

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