MEDICARE: STACY L OLSEN SLP-A

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	2355S0801X	Speech-Language Assistant	33271	TX

General Provider Information

NPI Number	:	1730313834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY L OLSEN SLP-A

Provider Business Mailing Address
First Line	:	13333 BLANCO RD STE 310
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-7756
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13333 BLANCO RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2138
Country	:	US
Telephone Number	:	210-479-5875
Fax Number	:

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

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/06/2026

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