Provider Demographics
NPI:1922316108
Name:O'LEARY, EMMETT L (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:L
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 S MCCOY DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1720
Mailing Address - Country:US
Mailing Address - Phone:719-566-6741
Mailing Address - Fax:
Practice Address - Street 1:401 IDAHO AVE
Practice Address - Street 2:
Practice Address - City:ORDWAY
Practice Address - State:CO
Practice Address - Zip Code:81063-1328
Practice Address - Country:US
Practice Address - Phone:719-267-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONOT APPLICABLE.235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist