Basic Information
| Provider Information | |||||||||
| NPI: | 1194155424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCONNELL | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 990 W BLUE GRASS RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488589566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897725875 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1524 PORTABELLA TRL | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488584006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897722967 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2013 | ||||||||
| LastUpdateDate: | 11/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7101002502 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.