Provider Demographics
NPI:1285901322
Name:CONNOLLY, KELLAINE (MS)
Entity type:Individual
Prefix:MS
First Name:KELLAINE
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E BROADWAY
Mailing Address - Street 2:SALEM CENTRAL SCHOOL DISTRICT
Mailing Address - City:SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:12865-3100
Mailing Address - Country:US
Mailing Address - Phone:518-854-9505
Mailing Address - Fax:518-854-6972
Practice Address - Street 1:41 E BROADWAY
Practice Address - Street 2:SALEM CENTRAL SCHOOL DISTRICT
Practice Address - City:SALEM
Practice Address - State:NY
Practice Address - Zip Code:12865-3100
Practice Address - Country:US
Practice Address - Phone:518-854-9505
Practice Address - Fax:518-854-6972
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant