Individual
OLIVIA MICKOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
2305 SE WASHINGTON ST STE 102, MILWAUKIE, OR 97222-7647
(503) 654-1014
(503) 654-1148
Mailing address
2305 SE WASHINGTON ST STE 102, MILWAUKIE, OR 97222-7647
(503) 654-1014
(503) 654-1148
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
015940
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015940
BSPA
OR
Enumeration date
12/06/2018
Last updated
12/06/2018
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