Provider Demographics
NPI:1750146486
Name:MCCONNELL, JESSICA ANNE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 LOGAN ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5528
Mailing Address - Country:US
Mailing Address - Phone:989-878-2494
Mailing Address - Fax:
Practice Address - Street 1:3300 VANBUREN ST.
Practice Address - Street 2:SUITE A6
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426
Practice Address - Country:US
Practice Address - Phone:989-878-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist