Provider Demographics
NPI:1588916506
Name:OLIVE, LAYLA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LAYLA
Middle Name:
Last Name:OLIVE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 MONTEREY BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2630
Mailing Address - Country:US
Mailing Address - Phone:614-301-8199
Mailing Address - Fax:
Practice Address - Street 1:2132 MONTEREY BLVD
Practice Address - Street 2:APT B
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254
Practice Address - Country:US
Practice Address - Phone:614-301-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 19248235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist