Provider Demographics
NPI:1073670717
Name:O'NEILL, ELIZABETH ERICKSON (AUD CCC-A)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ERICKSON
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HOPE AVE
Mailing Address - Street 2:BOSTON CHILDREN'S HOSPITAL @ WALTHAM
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2741
Mailing Address - Country:US
Mailing Address - Phone:781-216-2190
Mailing Address - Fax:781-216-2252
Practice Address - Street 1:9 HOPE AVE
Practice Address - Street 2:BOSTON CHILDREN'S HOSPITAL @ WALTHAM
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2741
Practice Address - Country:US
Practice Address - Phone:781-216-2190
Practice Address - Fax:781-216-2252
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA648231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAD0141OtherBLUE CROSS PROVIDER
MA35664Medicare ID - Type UnspecifiedMEDICARE PROVIDER