Provider Demographics
NPI:1548551245
Name:CONNERY, ANDREA MARY (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARY
Last Name:CONNERY
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:MARY
Other - Last Name:GRIFFITHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC SLP
Mailing Address - Street 1:4937 SPRING ROAD
Mailing Address - Street 2:PO BOX 168, MADISON ONELDA BOCES
Mailing Address - City:VERONA
Mailing Address - State:NY
Mailing Address - Zip Code:13478-0168
Mailing Address - Country:US
Mailing Address - Phone:315-269-9997
Mailing Address - Fax:
Practice Address - Street 1:4937 SPRING ROAD
Practice Address - Street 2:MADISON ONELDA BOCES
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-0168
Practice Address - Country:US
Practice Address - Phone:315-361-5902
Practice Address - Fax:315-361-5653
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017466-1235Z00000X
NYNYS 017466-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist