Provider Demographics
NPI:1457563868
Name:OCONNOR, MAUREEN JUDITH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:JUDITH
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 F ST
Mailing Address - Street 2:
Mailing Address - City:COLMA
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3160
Mailing Address - Country:US
Mailing Address - Phone:650-756-0153
Mailing Address - Fax:650-756-0153
Practice Address - Street 1:613 F ST
Practice Address - Street 2:
Practice Address - City:COLMA
Practice Address - State:CA
Practice Address - Zip Code:94014-3160
Practice Address - Country:US
Practice Address - Phone:650-756-0153
Practice Address - Fax:650-756-0153
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 1327235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist