MEDICARE: JANE F. CONNELLY AU.D. CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	5330	MN

General Provider Information

NPI Number	:	1750528824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE F. CONNELLY AU.D. CCC-A

Provider Business Mailing Address
First Line	:	430 WILDWOOD AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55110-1619
Country	:	US
Telephone Number	:	651-426-7658
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 CONCORDIA AVE
Second Line	:	RONDO ECSE
City	:	SAINT PAUL
State	:	MN
Zip	:	55103-2443
Country	:	US
Telephone Number	:	651-325-2699
Fax Number	:	651-325-2691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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