Provider Demographics
NPI:1104671403
Name:OLSEN, LAUREN FULKERSON
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:FULKERSON
Last Name:OLSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 SUNSET WALK LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7827
Mailing Address - Country:US
Mailing Address - Phone:919-710-5174
Mailing Address - Fax:
Practice Address - Street 1:5221 SUNSET WALK LN
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7827
Practice Address - Country:US
Practice Address - Phone:919-710-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30002873235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty