Provider Demographics
NPI:1649266008
Name:O'NEAL, WADE JR
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:O'NEAL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E PRIMROSE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7910
Mailing Address - Country:US
Mailing Address - Phone:417-890-9300
Mailing Address - Fax:417-890-9304
Practice Address - Street 1:1530 E PRIMROSE ST STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7910
Practice Address - Country:US
Practice Address - Phone:417-890-9300
Practice Address - Fax:417-890-9304
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2859237700000X
MO2004006107237700000X
235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist