Provider Demographics
NPI:1053189084
Name:KUTZKE, OLIVIA (SLP-A)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:KUTZKE
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 E HARTSON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2337
Mailing Address - Country:US
Mailing Address - Phone:425-289-8123
Mailing Address - Fax:
Practice Address - Street 1:524 S HALLETT ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-7000
Practice Address - Country:US
Practice Address - Phone:509-565-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASP613825672355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant