Provider Demographics
NPI:1831497734
Name:O'NEAL, MISTY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:O'NEAL
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 1:110 MAC NAIR ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-5043
Mailing Address - Country:US
Mailing Address - Phone:252-495-3977
Mailing Address - Fax:
Practice Address - Street 1:110 MAC NAIR ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-5043
Practice Address - Country:US
Practice Address - Phone:252-495-3977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8392235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist