Provider Demographics
NPI:1033403811
Name:CONNERY, ELLEN LOUISE (ELLEN CONNERY)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:LOUISE
Last Name:CONNERY
Suffix:
Gender:F
Credentials:ELLEN CONNERY
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:L
Other - Last Name:CONNERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ELLEN CONNERY
Mailing Address - Street 1:213 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3590
Mailing Address - Country:US
Mailing Address - Phone:401-284-1000
Mailing Address - Fax:401-284-1006
Practice Address - Street 1:213 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3590
Practice Address - Country:US
Practice Address - Phone:401-284-1000
Practice Address - Fax:401-284-1006
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist