Provider Demographics
NPI:1801184312
Name:CONNOLLY, MELISSA ANNE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-105 AKAKU PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2574
Mailing Address - Country:US
Mailing Address - Phone:808-518-1526
Mailing Address - Fax:888-314-9762
Practice Address - Street 1:95-221 KIPAPA DR STE E2
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1148
Practice Address - Country:US
Practice Address - Phone:808-518-1526
Practice Address - Fax:888-314-9762
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12099198235Z00000X
HISP-1210235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist