Provider Demographics
NPI:1932340650
Name:CAROLINE J. CONNELLY,MS/CCC-SLP,PC;PA
Entity Type:Organization
Organization Name:CAROLINE J. CONNELLY,MS/CCC-SLP,PC;PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP,PC;PA
Authorized Official - Phone:561-433-1345
Mailing Address - Street 1:7800 GREAT OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7110
Mailing Address - Country:US
Mailing Address - Phone:561-433-1345
Mailing Address - Fax:561-357-5720
Practice Address - Street 1:7800 GREAT OAK DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7110
Practice Address - Country:US
Practice Address - Phone:561-433-1345
Practice Address - Fax:561-357-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA4555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty