Provider Demographics
NPI:1619088317
Name:CONNELL, KATHLEEN (PCC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 N HIGH ST
Mailing Address - Street 2:SUITE 232
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2517
Mailing Address - Country:US
Mailing Address - Phone:614-504-5580
Mailing Address - Fax:614-436-1800
Practice Address - Street 1:6827 N HIGH ST
Practice Address - Street 2:SUITE 232
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2517
Practice Address - Country:US
Practice Address - Phone:614-504-5580
Practice Address - Fax:614-436-1800
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0500723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional