Provider Demographics
NPI:1295621902
Name:O'CONNELL, ERIN MARIE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-8501
Mailing Address - Country:US
Mailing Address - Phone:920-507-1414
Mailing Address - Fax:
Practice Address - Street 1:740 COMMUNITY DR A
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317
Practice Address - Country:US
Practice Address - Phone:319-626-2553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA132070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist