Healthcare Provider Details

I. General information

NPI: 1003536715
Provider Name (Legal Business Name): RACHAEL CONNELLY SPEECH PATHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 HARDER RD
HAYWARD CA
94544-2830
US

IV. Provider business mailing address

PO BOX 5000
HAYWARD CA
94540-0001
US

V. Phone/Fax

Practice location:
  • Phone: 805-452-1387
  • Fax:
Mailing address:
  • Phone: 510-784-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1336559
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number23148
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: