Provider Demographics
NPI:1932241973
Name:O'CONNELL, ANNETTE CAMERON (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:CAMERON
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MS, 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:PO BOX 3187
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-3187
Mailing Address - Country:US
Mailing Address - Phone:907-283-4300
Mailing Address - Fax:907-283-4362
Practice Address - Street 1:110 TRADING BAY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7716
Practice Address - Country:US
Practice Address - Phone:907-283-4300
Practice Address - Fax:907-283-4362
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK63235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP11532Medicaid