Doctor Name: | TRACY OLKONEN |
NPI Number: | 1487085981 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA-CCC-SLP |
License Number: | 3925-154 |
Business Practice Address: | 502 Copper St Ste 2 Hurley, WI - 545341386 |
Business Phone Number: | 7155612191 |
Business Fax Number: | |
Mailing Address: | N8940 Van Buskirk Rd, IRONWOOD |
State: | MI |
Postal Code: | 499389307 |
Phone Number: | 7158620278 |
Fax Number: | |
NPI Enumeration Date: | 12/09/2013 |
NPI Last Update Date: | 12/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3925-154 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |