Jordan Olson

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

4322-154 Issued in WI

Practice address

10108 74TH St
Kenosha, WI 53142-7514

Phone

(262) 671-2557

NPI assigned

May 25, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sundance Rehabilitation LLCGroup PAC ID 7911815329, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Sundance Rehabilitation LLC

  • Rehabilitation Clinic/Center
  • Deforest, WI
  • NPI 1073912119
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1464134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1962850412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10108 74TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10108 74TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531427514",
            "telephone_number": "262-671-2557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-25",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "4322-154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Ann Oleksak, MSCC, LPC
• Jeanne E Olsen, PA-C
• Melissa M Olsen, LCPC
• Nicholas Olsen, LCSW
• Shae Olsen, LCSW
• Joseph J Olszewski, MS LAT CSCS
• Kathryn A Omelina, NP
• Sosamma M Oommen
• Amy Opansky, OTRL CKTP
• Optimal Health & Balance LLC

• Speech-Language Pathologist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; 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.

Verify at the official NPI Registry.