Individual
JORDAN OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10108 74TH ST, KENOSHA, WI 53142-7514
(262) 671-2557
Mailing address
10108 74TH ST, KENOSHA, WI 53142-7514
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4322-154
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/25/2016
Last updated
06/08/2020
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