Provider Demographics
NPI:1619237567
Name:CONNELL, KERRI ANN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:ANN
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PARKHILL AVE
Mailing Address - Street 2:A
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4667
Mailing Address - Country:US
Mailing Address - Phone:516-382-2943
Mailing Address - Fax:
Practice Address - Street 1:125 PARKHILL AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4667
Practice Address - Country:US
Practice Address - Phone:516-382-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
NY023726235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist