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Olivia
Olivia
Lake
Provisional speech-language path...
Speech-language pathologist
Jacksonville,
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Florida Board of Medicine
Board Name
SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY
Full name
Olivia Paige Lake
Job Title
Speech-Language Pathologist
License Number
SA21764
License Status
Clear/Active
License Issue Date
26/07/2023
License Expiry Date
31/12/2025
Source Type
Professional Profile
Florida Health Care Practitioner Data Portal
Full name
Olivia Lake
Job Title
Provisional Speech-Language Pathologist
Location
Jacksonville, FL, USA
LIC ID
11281
Current License Expiration Date
02/05/2024
Original Date
02/08/2022
Professional Rank Code
SZ
Effective Date
02/08/2022
Board Action Indicator
N
License Status Description
CLEAR
Country Description
DUVAL
Practice Location Address Line 1
Apt. 331 4235 Marsh Landing Blvd.
Practice Location Address Line 2
Apt 331
Practice Location Address City
JACKSONVILLE BEACH
Practice Location Address State
FL
Practice Location Address Zipcode
32250
Prescribing Indicator
N
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