Healthcare Provider Details

I. General information

NPI: 1104712702
Provider Name (Legal Business Name): HAILLE BERGER AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 FARMINGTON AVE STE 101
WEST HARTFORD CT
06107-2673
US

IV. Provider business mailing address

1216 FARMINGTON AVE STE 101
WEST HARTFORD CT
06107-2673
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-9000
  • Fax:
Mailing address:
  • Phone: 860-236-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number813
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number813
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: