Provider Demographics
NPI:1992375455
Name:O'CALLAGHAN, SIANNA B
Entity Type:Individual
Prefix:MISS
First Name:SIANNA
Middle Name:B
Last Name:O'CALLAGHAN
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 1:13360 LANGE ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4419
Mailing Address - Country:US
Mailing Address - Phone:313-680-4919
Mailing Address - Fax:
Practice Address - Street 1:13360 LANGE ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4419
Practice Address - Country:US
Practice Address - Phone:313-680-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent