Provider Demographics
NPI:1861400525
Name:O'DONNELL, JANNA HELENE (AUD)
Entity type:Individual
Prefix:
First Name:JANNA
Middle Name:HELENE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 PACIFIC GROVE DR
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8493
Mailing Address - Country:US
Mailing Address - Phone:954-540-3278
Mailing Address - Fax:
Practice Address - Street 1:7305 N MILITARY TRL # 126
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1373231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51002258Medicare ID - Type Unspecified