Provider Demographics
NPI:1730568718
Name:CONNALLY, JANIS (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:CONNALLY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3648 SANTA MARIA LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3227
Mailing Address - Country:US
Mailing Address - Phone:805-569-2695
Mailing Address - Fax:
Practice Address - Street 1:621 W MICHELTORENA ST
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-4195
Practice Address - Country:US
Practice Address - Phone:805-253-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-24
Last Update Date:2015-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist