Provider Demographics
NPI:1982851739
Name:O'CONNOR, JILL MARIE (MSED/CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MSED/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6167 W QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2640
Mailing Address - Country:US
Mailing Address - Phone:716-560-0536
Mailing Address - Fax:
Practice Address - Street 1:90 PEARL ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4106
Practice Address - Country:US
Practice Address - Phone:716-362-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-23
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018105235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1982851739Medicaid