Individual
KELLY MARIE CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10416 S TRIPP AVE, OAK LAWN, IL 60453-4854
(708) 634-2703
Mailing address
10416 S TRIPP AVE, OAK LAWN, IL 60453-4854
(708) 634-2703
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
2427640
IL
222Q00000X
Developmental Therapist
Primary
2473045
IL
Other
Enumeration date
05/03/2011
Last updated
05/03/2011
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