Provider Demographics
NPI:1518182690
Name:O'CONNOR, VIRGINIA H (MACCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:H
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 KEYSER ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1019
Mailing Address - Country:US
Mailing Address - Phone:740-373-3781
Mailing Address - Fax:740-373-1373
Practice Address - Street 1:1701 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1335
Practice Address - Country:US
Practice Address - Phone:740-373-3781
Practice Address - Fax:740-373-1373
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP0039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist