Provider Demographics
NPI:1003536715
Name:CONNELLY, RACHAEL (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 S DENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62522-2636
Mailing Address - Country:US
Mailing Address - Phone:805-452-1387
Mailing Address - Fax:
Practice Address - Street 1:MT ZION ELEMENTARY
Practice Address - Street 2:725 W MAIN ST
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549
Practice Address - Country:US
Practice Address - Phone:217-864-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1336559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist