Healthcare Provider Details

I. General information

NPI: 1922554310
Provider Name (Legal Business Name): JUSTINE O'CALLAGHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8733 HOLLY SPRINGS RD
APEX NC
27539-9194
US

IV. Provider business mailing address

8733 HOLLY SPRINGS RD
APEX NC
27539-9194
US

V. Phone/Fax

Practice location:
  • Phone: 919-981-6588
  • Fax: 919-386-4967
Mailing address:
  • Phone: 919-981-6588
  • Fax: 919-386-4967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30001938
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22824
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: