Provider Demographics
NPI:1790071082
Name:GUDGEL O'CONNELL, KERRIGAN (MS CFY)
Entity Type:Individual
Prefix:
First Name:KERRIGAN
Middle Name:
Last Name:GUDGEL O'CONNELL
Suffix:
Gender:F
Credentials:MS CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 S 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-2241
Mailing Address - Country:US
Mailing Address - Phone:406-550-3431
Mailing Address - Fax:
Practice Address - Street 1:1931 S 3RD ST W
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-2241
Practice Address - Country:US
Practice Address - Phone:406-550-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist