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General NPI Number Information
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NPI Number | 1023602240
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Entity Type | Individual
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Provider Name | JAIME O'NEIL
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Gender | Female
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Dates
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Enumeration Date | 02/28/2021
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Last Update Date | 02/28/2021
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Provider Practice Location Address
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Address Line | 31 VAUXHALL ST
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City | NEW LONDON
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State | CT
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Zip | 06320-5723
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Country | US
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Telephone | 860-442-4363
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Fax |
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Provider Business Mailing Address
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Address Line | 121 SHEEPSKIN HOLLOW RD
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City | EAST HADDAM
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State | CT
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Zip | 06423-1515
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Country | US
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Telephone | 802-688-4635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 18.006158
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License Number State | CT
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