Healthcare Provider Details

I. General information

NPI: 1902671209
Provider Name (Legal Business Name): ABIGAILE CONNOLLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABI CONNOLLY

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 S INDUSTRIAL HWY STE 100
ANN ARBOR MI
48104-6791
US

IV. Provider business mailing address

2805 S INDUSTRIAL HWY STE 100
ANN ARBOR MI
48104-6791
US

V. Phone/Fax

Practice location:
  • Phone: 734-210-0717
  • Fax:
Mailing address:
  • Phone: 734-210-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: