Active NPI
Olivia Nicole Dallas
- Speech-Language Pathologist
- Newark, DE
National Provider Identifier
1962238337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 540 S College Ave Ste 102
Newark, DE 19713-1302 - Phone
- (302) 831-7100
- Fax
- (302) 831-7101
- NPI assigned
- Sep 11, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
540 S College Ave Ste 102
Newark, DE 19713-1302
Mailing address
502 Bramblewood Dr
Douglassville, PA 19518-1248
Phone (484) 624-7991
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DE
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241018000129 | DE | Practitioner - Qualified Speech Language Pathologist | 8921530742 |
Care Compare profile
Medicare Care Compare- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
540 S College Ave
Suite 102
Newark, DE 19713-1302
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1726012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1726012800000",
"number": "1962238337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "502 BRAMBLEWOOD DR",
"city": "DOUGLASSVILLE",
"state": "PA",
"postal_code": "195181248",
"telephone_number": "484-624-7991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 S COLLEGE AVE STE 102",
"city": "NEWARK",
"state": "DE",
"postal_code": "197131302",
"telephone_number": "302-831-7100",
"fax_number": "302-831-7101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DALLAS",
"first_name": "OLIVIA",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-11",
"last_updated": "2024-09-11",
"certification_date": "2024-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.