Provider Demographics
NPI:1053937714
Name:BROWN, OLIVIA STANISIC (MS, SLP-CCC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:STANISIC
Last Name:BROWN
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:CLARE
Other - Last Name:STANISIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, SLP-CCC
Mailing Address - Street 1:1631 W WARREN BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-2602
Mailing Address - Country:US
Mailing Address - Phone:574-339-6507
Mailing Address - Fax:
Practice Address - Street 1:1631 W WARREN BLVD APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2602
Practice Address - Country:US
Practice Address - Phone:574-339-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2419507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist