Provider Demographics
NPI:1891208625
Name:OCONNELL, PATRICIA FERNANDA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:FERNANDA
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 S NEENAH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-3305
Mailing Address - Country:US
Mailing Address - Phone:773-229-9049
Mailing Address - Fax:
Practice Address - Street 1:5715 S NEENAH AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-3305
Practice Address - Country:US
Practice Address - Phone:773-229-9049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist