Healthcare Provider Details

I. General information

NPI: 1780977603
Provider Name (Legal Business Name): SOUND AUDIOLOGY AND HEARING AID CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 NORWICH WESTERLY RD BOX #6
NORTH STONINGTON CT
06359-1744
US

IV. Provider business mailing address

82 NORWICH WESTERLY RD BOX #6
NORTH STONINGTON CT
06359-1744
US

V. Phone/Fax

Practice location:
  • Phone: 860-495-5582
  • Fax:
Mailing address:
  • Phone: 860-495-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number000289
License Number StateCT

VIII. Authorized Official

Name: COLLEEN RYANS HICKS
Title or Position: OWNER/AUDIOLOGIST
Credential: M.ED., M.S., CCC/A
Phone: 860-495-5582