Individual
AMY L OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
1835 WILDWOOD ST, BOISE, ID 83713-5146
(208) 252-0847
Mailing address
11956 W FAIRVIEW AVE APT J115, BOISE, ID 83713-8089
(208) 252-0847
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
67620353
—
CO
Enumeration date
10/03/2015
Last updated
08/25/2021
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