Basic Information
| Provider Information | |||||||||
| NPI: | 1184279747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'DONNELL | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | MAIRE | ||||||||
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| Credential: | AU.D., CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2365 S CLINTON AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2365 S CLINTON AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146182663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857585700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2019 | ||||||||
| LastUpdateDate: | 09/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 002908 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.