Provider Demographics
NPI:1548472582
Name:MCCONNELL, GINALYN ANN (MCDSLP)
Entity type:Individual
Prefix:
First Name:GINALYN
Middle Name:ANN
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MCDSLP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:ANN
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MCDSLP
Mailing Address - Street 1:75 INLET DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5705
Mailing Address - Country:US
Mailing Address - Phone:504-512-5507
Mailing Address - Fax:985-847-9930
Practice Address - Street 1:75 INLET DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5705
Practice Address - Country:US
Practice Address - Phone:504-512-5507
Practice Address - Fax:985-847-9930
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3293235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1199931Medicaid