Provider Demographics
NPI:1659064814
Name:O'CONNELL, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
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 1:985 SUN CITY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7519
Mailing Address - Country:US
Mailing Address - Phone:916-209-3443
Mailing Address - Fax:
Practice Address - Street 1:985 SUN CITY LN STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7519
Practice Address - Country:US
Practice Address - Phone:916-209-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA61377831237700000X
CA8931237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist