Individual
JACQUELINE BALZER O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2924 BROOK RD, CHILDREN'S HOSPITAL CREDENTIALING DEPT, RICHMOND, VA 23220-1215
(804) 321-7474
(804) 321-2728
Mailing address
2924 BROOK RD, CHILDREN'S HOSPITAL CREDENTIALING DEPT, RICHMOND, VA 23220-1215
(804) 321-7474
(804) 321-2728
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202004860
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00499076
—
VA
Enumeration date
12/08/2006
Last updated
07/08/2007
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