Individual
CARISSA JO O'DONOGHUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
1000 RAILER WAY, LINCOLN, IL 62656
(217) 732-4131
Mailing address
816 7TH ST, LINCOLN, IL 62656-2449
(217) 322-7142
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146013208
IL
Other
Enumeration date
09/15/2017
Last updated
09/15/2017
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