Healthcare Provider Details

I. General information

NPI: 1801591359
Provider Name (Legal Business Name): BRITTANY CONNOR MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY HURSH

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 JOHN KISSINGER DR
WABASH IN
46992-1648
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-563-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22007165A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: