Individual
MS. NANCY J OLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M,A, CCC-SLP
Contact information
Practice address
611 KORTE WAY, LONGMONT, CO 80501-6366
(303) 776-7417
Mailing address
PO BOX 21463, BOULDER, CO 80308-4463
(720) 221-8939
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12103437
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0405638
INITIAL SPECIAL SERVICES LICENSE
CO
01
—
12103437
ASHA CERTIFICATION NUMBER
CO
Enumeration date
06/09/2009
Last updated
06/09/2009
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