Provider Demographics
NPI:1972485118
Name:VINUP, OLIVIA (AUD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:VINUP
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 SHAKORI DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-4163
Mailing Address - Country:US
Mailing Address - Phone:928-287-0977
Mailing Address - Fax:
Practice Address - Street 1:2074 LAKE TAHOE BLVD STE 9
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6417
Practice Address - Country:US
Practice Address - Phone:530-537-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU4045231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist