Provider Demographics
NPI:1558791897
Name:O'CONNELL, LISA OLIVER (MACCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:OLIVER
Last Name:O'CONNELL
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 1:2470 FAIRVIEW FARM RD
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27205-8633
Mailing Address - Country:US
Mailing Address - Phone:336-803-3385
Mailing Address - Fax:
Practice Address - Street 1:2470 FAIRVIEW FARM RD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27205-8633
Practice Address - Country:US
Practice Address - Phone:336-803-3385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2312235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist