Provider Demographics
NPI:1194603472
Name:SPOSATO, OLIVIA LENORE
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LENORE
Last Name:SPOSATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5210
Mailing Address - Country:US
Mailing Address - Phone:845-294-0661
Mailing Address - Fax:845-360-9339
Practice Address - Street 1:2004 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-5210
Practice Address - Country:US
Practice Address - Phone:845-294-0661
Practice Address - Fax:845-360-9339
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034940-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist