Provider Demographics
NPI:1912393950
Name:O'DONNELL, AMY E (MED, CCC-A)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:MED, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 S. ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411
Mailing Address - Country:US
Mailing Address - Phone:361-854-7000
Mailing Address - Fax:361-814-2685
Practice Address - Street 1:3318 S. ALAMEDA
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-854-7000
Practice Address - Fax:361-814-2685
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80642231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist