Kelley J Olenick, AU.D.

Primary specialty

Audiologist-Hearing Aid FitterTaxonomy code 237600000X

License

H-243 Issued in ID

Practice address

4155 Yellowstone Ave
Pine Ridge Mall
Pocatello, ID 83202-2345

Phone

(208) 238-0020

Fax

(208) 238-0021

NPI assigned

Nov 16, 2006

Last updated

Aug 22, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Eastern Idaho Audiology, LLC

  dba Pocatello Hearing Zone

  • Audiologist-Hearing Aid Fitter
  • Chubbuck, ID
  • NPI 1972833481
  Authorized official Same address or phone

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187740800000",
    "number": "1437222668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4155 YELLOWSTONE AVE",
            "address_2": "PINE RIDGE MALL",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832022345",
            "telephone_number": "208-238-0020",
            "fax_number": "208-238-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4155 YELLOWSTONE AVE",
            "address_2": "PINE RIDGE MALL",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832022345",
            "telephone_number": "208-238-0020",
            "fax_number": "208-238-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLENICK",
        "first_name": "KELLEY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2007-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "ID",
            "license": "H-243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GRP #AU-365",
            "identifier": "AU-449",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ID",
            "identifier": "AU-456",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BCBS",
            "identifier": "000010141365",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF ID",
            "identifier": "000010150424",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA DEPT OF LABOR",
            "identifier": "0174362",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Audiologist-Hearing Aid Fitter in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Audiologist-Hearing Aid Fitter in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; 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.