Provider Demographics
NPI:1750707543
Name:OCONNELL, JOANNE THERESA (MED, MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:THERESA
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:MED, MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RUDDER RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3562
Mailing Address - Country:US
Mailing Address - Phone:413-657-9930
Mailing Address - Fax:
Practice Address - Street 1:17 RUDDER RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3562
Practice Address - Country:US
Practice Address - Phone:413-657-9930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist