Provider Demographics
NPI:1700092152
Name:O'NEILL, JAN (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 TRALEE RD
Mailing Address - Street 2:104
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3831
Mailing Address - Country:US
Mailing Address - Phone:410-296-8888
Mailing Address - Fax:
Practice Address - Street 1:7401 OSLER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7673
Practice Address - Country:US
Practice Address - Phone:410-296-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist