Provider Demographics
NPI:1659196228
Name:O'DONNELL, ISABELLA M (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:M
Last Name:O'DONNELL
Suffix:
Gender:F
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 1:5797 MCCLINTOCK DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0169
Mailing Address - Country:US
Mailing Address - Phone:406-546-8896
Mailing Address - Fax:
Practice Address - Street 1:1343 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5137
Practice Address - Country:US
Practice Address - Phone:704-785-0560
Practice Address - Fax:980-224-8387
Is Sole Proprietor?:No
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003539235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist