MEDICARE: COLUMBUS SPEECH THERAPY

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	813	NE

General Provider Information

NPI Number	:	1710118385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS SPEECH THERAPY

Provider Business Mailing Address
First Line	:	2656 33RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2314
Country	:	US
Telephone Number	:	402-564-1212
Fax Number	:	402-564-1499

Provider Business Practice Location Address
First Line	:	2656 33RD AVE
Second Line	:
City	:	COLUMBUS
State	:	NE
Zip	:	68601-2314
Country	:	US
Telephone Number	:	402-564-1212
Fax Number	:	402-564-1499

Authorized Official
Title or Position	:	OWNER/SLP
Name	:	MRS. DEBRA ELLEN OLSON
Credential	:	MS/CCC-SLP
Telephone Number	:	402-564-1212

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	07/30/2009

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Directions to “COLUMBUS SPEECH THERAPY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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