Healthcare Provider Details

I. General information

NPI: 1568079259
Provider Name (Legal Business Name): LAURA PARIS KUZOIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2020
Last Update Date: 09/26/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 HARTFORD TPKE
VERNON CT
06066-4560
US

IV. Provider business mailing address

120 DEERFIELD DR
BERLIN CT
06037-3028
US

V. Phone/Fax

Practice location:
  • Phone: 860-875-0771
  • Fax:
Mailing address:
  • Phone: 860-944-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6274
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: