Provider Demographics
NPI:1184193435
Name:MORIN-CONNOLLY, GISELE MARIE
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:MARIE
Last Name:MORIN-CONNOLLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12113 BLUE PAPER TRL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2787
Mailing Address - Country:US
Mailing Address - Phone:410-997-3652
Mailing Address - Fax:
Practice Address - Street 1:11630 SCAGGSVILLE RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MD
Practice Address - Zip Code:20759-2208
Practice Address - Country:US
Practice Address - Phone:410-888-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01287235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist