Provider Demographics
NPI:1669667291
Name:CONNELLY, HEATHER DIANE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DIANE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:DIANE
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:207 W HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3943
Mailing Address - Country:US
Mailing Address - Phone:630-248-7006
Mailing Address - Fax:630-248-7006
Practice Address - Street 1:207 W HARTFORD DR
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3943
Practice Address - Country:US
Practice Address - Phone:630-394-9985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242000436235Z00000X
235Z00000X
IL146009223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist