Provider Demographics
NPI:1891034773
Name:O'REILLY, EUGENE (MACCCSLP)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:O'REILLY
Suffix:
Gender:M
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 JOHN MUIR DR APT 320
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-6133
Mailing Address - Country:US
Mailing Address - Phone:415-586-2944
Mailing Address - Fax:
Practice Address - Street 1:595 JOHN MUIR DR APT 320
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-6133
Practice Address - Country:US
Practice Address - Phone:415-586-2944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP9363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist