Provider Demographics
NPI:1548315625
Name:OLESKI, MERRITT STEPHEN (PHD)
Entity type:Individual
Prefix:DR
First Name:MERRITT
Middle Name:STEPHEN
Last Name:OLESKI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 ALTAVIEW CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2701
Mailing Address - Country:US
Mailing Address - Phone:513-739-5892
Mailing Address - Fax:
Practice Address - Street 1:11590 CENTURY BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3326
Practice Address - Country:US
Practice Address - Phone:513-671-7246
Practice Address - Fax:513-671-4786
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3319103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3438131400OtherBWC
OH3438131400OtherBWC