Provider Demographics
NPI:1306261425
Name:WELLY-COMBS, CONNYE R (MS, CCC/SLP)
Entity type:Individual
Prefix:
First Name:CONNYE
Middle Name:R
Last Name:WELLY-COMBS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:CONNYE
Other - Middle Name:R
Other - Last Name:COMBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:300 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3082
Mailing Address - Country:US
Mailing Address - Phone:567-220-6545
Mailing Address - Fax:
Practice Address - Street 1:300 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3082
Practice Address - Country:US
Practice Address - Phone:567-220-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5685235Z00000X
OH5685235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5685OtherLICENSE, STATE OF OHIO