Provider Demographics
NPI:1457693046
Name:CONNELL, KELLY HEMPHILL (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:HEMPHILL
Last Name:CONNELL
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 1:424 WESTOVER DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-9773
Mailing Address - Country:US
Mailing Address - Phone:662-624-9618
Mailing Address - Fax:
Practice Address - Street 1:1742 CHERYL ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-7218
Practice Address - Country:US
Practice Address - Phone:662-627-5247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS1162235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist