Individual provider Active NPI

Nancy J Olin, M,A, CCC-SLP

  • Speech-Language Pathologist
  • Longmont, CO
National Provider Identifier
1174759724
Registry record updated Jun 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
12103437 Issued in CO
Practice address
611 Korte Way
Longmont, CO 80501-6366
Phone
(303) 776-7417
NPI assigned
Jun 9, 2009
Last updated
Jun 9, 2009By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 12103437 CO Primary

Addresses

Primary practice location

611 Korte Way
Longmont, CO 80501-6366

Mailing address

PO Box 21463
Boulder, CO 80308-4463
Phone (720) 221-8939

Other identifiers 2

IdentifierTypeStateIssuer
0405638OtherCOINITIAL SPECIAL SERVICES LICENSE
12103437OtherCOASHA CERTIFICATION NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
12103437COMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
TLC Learning Center Inc. Speech-Language Pathologist Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244505600000",
    "number": "1174759724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21463",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803084463",
            "telephone_number": "720-221-8939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 KORTE WAY",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016366",
            "telephone_number": "303-776-7417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIN",
        "first_name": "NANCY",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "M,A, CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2009-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CO",
            "license": "12103437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INITIAL SPECIAL SERVICES LICENSE",
            "identifier": "0405638",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA CERTIFICATION NUMBER",
            "identifier": "12103437",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.