Provider Demographics
NPI:1487878880
Name:OLSON, MELINDA (MED, CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:OLSON
Suffix:
Gender:F
Credentials:MED, CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 E DULSE ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7144
Mailing Address - Country:US
Mailing Address - Phone:903-595-3524
Mailing Address - Fax:
Practice Address - Street 1:1002 E DULSE ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7144
Practice Address - Country:US
Practice Address - Phone:903-595-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100050235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87895TOtherBLUE CROSS BLUE SHIELD