Provider Demographics
NPI:1538306246
Name:O'CONNOR, NANCY RUSSELL (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:RUSSELL
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 CHACE HILL RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564-1519
Mailing Address - Country:US
Mailing Address - Phone:978-502-9604
Mailing Address - Fax:
Practice Address - Street 1:354 W BOYLSTON ST
Practice Address - Street 2:SUITE 231
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2373
Practice Address - Country:US
Practice Address - Phone:978-502-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist