Provider Demographics
NPI:1891390191
Name:O'CONNER, CHIANTAY (SLPA)
Entity Type:Individual
Prefix:MS
First Name:CHIANTAY
Middle Name:
Last Name:O'CONNER
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9673 GRAND TETON AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-4014
Mailing Address - Country:US
Mailing Address - Phone:225-456-4616
Mailing Address - Fax:
Practice Address - Street 1:3462 ALETHA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-4601
Practice Address - Country:US
Practice Address - Phone:225-221-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA83442355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant