Provider Demographics
NPI:1215298690
Name:OCONNOR, JOHNNY R JR (CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:R
Last Name:OCONNOR
Suffix:JR
Gender:M
Credentials: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 535
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-0535
Mailing Address - Country:US
Mailing Address - Phone:832-414-9701
Mailing Address - Fax:
Practice Address - Street 1:14438 COTTAGE TIMBERS LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-4446
Practice Address - Country:US
Practice Address - Phone:832-414-9701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-02
Last Update Date:2012-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist