Provider Demographics
NPI:1104124296
Name:COMMUNICATION CONNECTION, LLC
Entity type:Organization
Organization Name:COMMUNICATION CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:601-798-6900
Mailing Address - Street 1:117B N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-3928
Mailing Address - Country:US
Mailing Address - Phone:601-798-6900
Mailing Address - Fax:601-798-6975
Practice Address - Street 1:117B N MAIN ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3928
Practice Address - Country:US
Practice Address - Phone:601-798-6900
Practice Address - Fax:601-798-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3402235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04578859Medicaid