Provider Demographics
NPI:1912100645
Name:OCONNOR, ELISABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELISABETH
Middle Name:
Last Name:OCONNOR
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 1:6308 THERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7130
Mailing Address - Country:US
Mailing Address - Phone:919-870-1355
Mailing Address - Fax:
Practice Address - Street 1:6308 THERFIELD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7130
Practice Address - Country:US
Practice Address - Phone:919-870-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2622235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC74633503Medicaid