Provider Demographics
NPI:1023391968
Name:O'NEILL, KERRI
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:O'NEILL
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 1:6330 LBJ FWY
Mailing Address - Street 2:SUITE 136
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6467
Mailing Address - Country:US
Mailing Address - Phone:972-233-9019
Mailing Address - Fax:
Practice Address - Street 1:6330 LBJ FWY
Practice Address - Street 2:SUITE 136
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6467
Practice Address - Country:US
Practice Address - Phone:972-233-9019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10574235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist