Provider Demographics
NPI:1770606766
Name:OLSON, CARISA NICOLE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:CARISA
Middle Name:NICOLE
Last Name:OLSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 SUGAR BUSH LN S
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2000
Mailing Address - Country:US
Mailing Address - Phone:317-748-7553
Mailing Address - Fax:
Practice Address - Street 1:11688 LAKE FOREST PKWY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7208
Practice Address - Country:US
Practice Address - Phone:317-818-8166
Practice Address - Fax:317-818-8266
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003928A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN22003928AOtherSTATE LICENSE #
IN12061474OtherNATIONAL ASSOC. #