Provider Demographics
NPI:1740725266
Name:O'NEILL, ANA (MS)
Entity type:Individual
Prefix:MS
First Name:ANA
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 THEODORE ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-9197
Mailing Address - Country:US
Mailing Address - Phone:802-434-2757
Mailing Address - Fax:
Practice Address - Street 1:2712 THEODORE ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-9197
Practice Address - Country:US
Practice Address - Phone:802-434-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0121173-PROV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist