Provider Demographics
NPI:1619495702
Name:CONNER, AIMEE LEE (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:LEE
Last Name:CONNER
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:LEE
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8009 GRANDVISTA AVE
Mailing Address - Street 2:
Mailing Address - City:AFFTON
Mailing Address - State:MO
Mailing Address - Zip Code:63123-2605
Mailing Address - Country:US
Mailing Address - Phone:313-570-1626
Mailing Address - Fax:
Practice Address - Street 1:110 W SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1755
Practice Address - Country:US
Practice Address - Phone:636-583-1202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017022089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist