Provider Demographics
NPI:1366766115
Name:CONNELLY, SUZANNE ELAINE (MS, CCC-SLP, TSSLD)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:ELAINE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3048 LINDEN PL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1928
Mailing Address - Country:US
Mailing Address - Phone:718-281-3432
Mailing Address - Fax:
Practice Address - Street 1:3048 LINDEN PL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1928
Practice Address - Country:US
Practice Address - Phone:718-281-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist