Healthcare Provider Details

I. General information

NPI: 1164693966
Provider Name (Legal Business Name): COLLEEN O'DONNELL AUD, CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 MAIN ST SUITE 201
PHOENIXVILLE PA
19460-4478
US

IV. Provider business mailing address

826 MAIN ST SUITE 201
PHOENIXVILLE PA
19460-4478
US

V. Phone/Fax

Practice location:
  • Phone: 610-415-1100
  • Fax:
Mailing address:
  • Phone: 610-415-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT001097L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: