Provider Demographics
NPI:1548818024
Name:O'HARA, LAURA (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:O'HARA
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W CLAY ST
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-3205
Mailing Address - Country:US
Mailing Address - Phone:618-346-6350
Mailing Address - Fax:
Practice Address - Street 1:123 W CLAY ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-3205
Practice Address - Country:US
Practice Address - Phone:618-346-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008684235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist