Healthcare Provider Details

I. General information

NPI: 1821317298
Provider Name (Legal Business Name): SUSAN J. CHIN CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN J. ZIEGLER CCC-A

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BARNES RD SUITE 207
WALLINGFORD CT
06492-1832
US

IV. Provider business mailing address

888 WORCESTER ST SUITE 130
WELLESLEY MA
02482-3744
US

V. Phone/Fax

Practice location:
  • Phone: 203-678-1201
  • Fax: 203-678-1209
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000308
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: