Provider Demographics
NPI:1154032282
Name:OLAUSON, JENNICA LOUISE
Entity type:Individual
Prefix:
First Name:JENNICA
Middle Name:LOUISE
Last Name:OLAUSON
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 1:13388 S ROCKHOUSE CANYON TRL
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-0419
Mailing Address - Country:US
Mailing Address - Phone:909-240-8255
Mailing Address - Fax:
Practice Address - Street 1:13388 S ROCKHOUSE CANYON TRL
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-0419
Practice Address - Country:US
Practice Address - Phone:909-240-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA140152355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant