Provider Demographics
NPI:1528009834
Name:O'CONNOR, JULIA (ST)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 LAMBETH DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5800
Mailing Address - Country:US
Mailing Address - Phone:919-781-5728
Mailing Address - Fax:919-781-5744
Practice Address - Street 1:4104 LAMBETH DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5800
Practice Address - Country:US
Practice Address - Phone:919-781-5728
Practice Address - Fax:919-781-5744
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411565Medicaid
NC12431OtherBCBS GROUP