Provider Demographics
NPI:1144031147
Name:MEDDERS, OLIVIA G
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:G
Last Name:MEDDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17411 MAGNOLIA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5925
Mailing Address - Country:US
Mailing Address - Phone:407-271-7520
Mailing Address - Fax:
Practice Address - Street 1:717 OLD TROLLEY RD STE 227-6
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5287
Practice Address - Country:US
Practice Address - Phone:803-566-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.9121SPA2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant