Provider Demographics
NPI:1487015202
Name:DE LEON, OLGA CHRISTINA (SLP)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:CHRISTINA
Last Name:DE LEON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:OLGA
Other - Middle Name:CHRISTINA
Other - Last Name:DE LEON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:1841 SANTA YNEZ COURT
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301
Mailing Address - Country:US
Mailing Address - Phone:209-947-3892
Mailing Address - Fax:
Practice Address - Street 1:4605 VIA GIARDIANO
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95357-0661
Practice Address - Country:US
Practice Address - Phone:209-505-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16085235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist