Provider Demographics
NPI:1306243977
Name:O'CONNELL, HOLLEY (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:HOLLEY
Middle Name:
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 1:2411 JARVIS ST SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-2686
Mailing Address - Country:US
Mailing Address - Phone:205-965-9489
Mailing Address - Fax:
Practice Address - Street 1:2411 JARVIS ST SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-2686
Practice Address - Country:US
Practice Address - Phone:205-965-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2481235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist