Provider Demographics
NPI:1578825329
Name:ODONNELL, EVA L (SLP)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:L
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 SW COCONUT KEY WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1907
Mailing Address - Country:US
Mailing Address - Phone:772-240-4382
Mailing Address - Fax:
Practice Address - Street 1:357 SW COCONUT KEY WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1907
Practice Address - Country:US
Practice Address - Phone:772-240-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist