Provider Demographics
NPI:1386696482
Name:OLSEN, DIANE (SPT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:OLSEN
Suffix:
Gender:F
Credentials:SPT
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MONZELOWSKY-CAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPT
Mailing Address - Street 1:2237 E MONTEBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2715
Mailing Address - Country:US
Mailing Address - Phone:480-380-2810
Mailing Address - Fax:480-380-2861
Practice Address - Street 1:2414 N TRENTON
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-2527
Practice Address - Country:US
Practice Address - Phone:480-380-2810
Practice Address - Fax:480-380-2861
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist