Provider Demographics
NPI:1659549996
Name:O'CONNOR, SARA JETT (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JETT
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 1:2724 CARRETERA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-4060
Mailing Address - Country:US
Mailing Address - Phone:617-319-4681
Mailing Address - Fax:
Practice Address - Street 1:2724 CARRETERA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-4060
Practice Address - Country:US
Practice Address - Phone:617-319-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist