Provider Demographics
NPI:1205151206
Name:CONNELLY, ERIN S (SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:S
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:SUSAN
Other - Last Name:SPIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:110 N LARK LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2017
Mailing Address - Country:US
Mailing Address - Phone:618-303-6088
Mailing Address - Fax:
Practice Address - Street 1:2907 WILLIAMSON COUNTY PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5256
Practice Address - Country:US
Practice Address - Phone:618-998-9894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146008023235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist