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General NPI Number Information
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NPI Number | 1396350583
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Entity Type | Individual
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Provider Name | COLLEEN ALLISON O'CONNOR
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 6210 BELCREST RD APT 1440
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City | WEST HYATTSVILLE
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State | MD
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Zip | 20782-2957
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Country | US
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Telephone | 301-531-5309
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Fax |
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Provider Business Mailing Address
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Address Line | 6210 BELCREST RD APT 1440
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City | WEST HYATTSVILLE
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State | MD
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Zip | 20782-2957
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Country | US
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Telephone |
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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 | 02146L
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License Number State | MD
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