Provider Demographics
NPI:1376815027
Name:O'CONNOR, JENNIFER ANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-5427
Mailing Address - Country:US
Mailing Address - Phone:512-533-9313
Mailing Address - Fax:512-533-9317
Practice Address - Street 1:3211 HANCOCK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-5427
Practice Address - Country:US
Practice Address - Phone:512-533-9313
Practice Address - Fax:512-533-9317
Is Sole Proprietor?:No
Enumeration Date:2012-01-27
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist