MEDICARE: AMY L OLSON MA, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285004143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L OLSON MA, CCC-SLP

Provider Business Mailing Address
First Line	:	11956 W FAIRVIEW AVE APT J115
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-8089
Country	:	US
Telephone Number	:	208-252-0847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 WILDWOOD ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-5146
Country	:	US
Telephone Number	:	208-252-0847
Fax Number	:

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

Provider Enumeration Date	:	10/03/2015
Last Update Date	:	08/25/2021

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