Provider Demographics
NPI:1134546369
Name:O'CONNOR, STEPHANIE MARIE (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NORTH ERIE BLVD. SUITE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:513-887-3710
Mailing Address - Fax:513-887-3719
Practice Address - Street 1:600 E. BROADWAY STREET
Practice Address - Street 2:HARRISON ELEMENTARY
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030
Practice Address - Country:US
Practice Address - Phone:513-367-4161
Practice Address - Fax:513-367-1856
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP8252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist