=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457239808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RYAN ELIZABETH CONNOLLY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2025
-----------------------------------------------------
Last Update Date | 08/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7301 W PALMETTO PARK RD STE 201B207A
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33433-3458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-571-7557
-----------------------------------------------------
Fax | 561-405-9301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 630 E WOOLBRIGHT RD APT 302
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33435-6197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 795286
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------