Provider Demographics
NPI:1134617871
Name:O'CONNOR, EMILY E (CCC-SLP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:E
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ESTELLE
Other - Last Name:KOLANKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:14200 THE LAKES BLVD APT 613
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3783
Mailing Address - Country:US
Mailing Address - Phone:512-777-9863
Mailing Address - Fax:
Practice Address - Street 1:2011 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5945
Practice Address - Country:US
Practice Address - Phone:281-997-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist