Basic Information
| Provider Information | |||||||||
| NPI: | 1558793604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7551 9TH ST N | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OAKDALE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551286629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517484338 | ||||||||
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| Practice Location | |||||||||
| Address1: | 355 RIVER RD | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557443785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189997213 | ||||||||
| FaxNumber: | 2189997213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 10/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 6089 | MN | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.