Provider Demographics
NPI:1487085981
Name:OLKONEN, TRACY (MA-CCC-SLP)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:OLKONEN
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8940 VAN BUSKIRK RD
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9307
Mailing Address - Country:US
Mailing Address - Phone:715-862-0278
Mailing Address - Fax:
Practice Address - Street 1:502 COPPER ST STE 2
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:WI
Practice Address - Zip Code:54534-1386
Practice Address - Country:US
Practice Address - Phone:715-561-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3925-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist