Healthcare Provider Details

I. General information

NPI: 1336894047
Provider Name (Legal Business Name): ALICIA NICHOLE O'NEILL M.A. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N MILLER RD STE 150A
FAIRLAWN OH
44333-3713
US

IV. Provider business mailing address

440 HEATHER LN
MEDINA OH
44256-1614
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-2240
  • Fax: 330-630-3198
Mailing address:
  • Phone: 330-635-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.11019
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: