Provider Demographics
NPI:1770720393
Name:CONNELLY, ANN DONELL (MED)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:DONELL
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 W DARREL RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7005
Mailing Address - Country:US
Mailing Address - Phone:602-218-6742
Mailing Address - Fax:
Practice Address - Street 1:7305 W DARREL RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7005
Practice Address - Country:US
Practice Address - Phone:602-218-6742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor