Provider Demographics
NPI:1518245125
Name:CONNOLLY, AMITY E (SLP)
Entity Type:Individual
Prefix:
First Name:AMITY
Middle Name:E
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 W MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6951
Mailing Address - Country:US
Mailing Address - Phone:480-861-1506
Mailing Address - Fax:
Practice Address - Street 1:875 S COOPER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233
Practice Address - Country:US
Practice Address - Phone:480-456-0942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-30
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist