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General NPI Number Information
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NPI Number | 1932575610
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Entity Type | Organization
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Legal Business Name | SOUTHBURY AUDIOLOGY LLC
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 2 POMPERAUG OFFICE PARK SUITE 307
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City | SOUTHBURY
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State | CT
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Zip | 06488-2288
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Country | US
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Telephone | 203-264-8201
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Fax | 203-264-8201
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Provider Business Mailing Address
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Address Line | 2 POMPERAUG OFFICE PARK SUITE 307
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City | SOUTHBURY
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State | CT
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Zip | 06488-2288
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Country | US
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Telephone | 203-264-8201
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Fax | 203-264-8201
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Authorized Official
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Title or Position | SOLE MEMBER OWNER LLC
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Name | DR. CATHLEEN ANNE ALEX
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Credential | AUD
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Telephone | 203-264-8201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231HA2400X
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Taxonomy Name | Assistive Technology Practitioner Audiologist
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License Number | 109
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 231HA2500X
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Taxonomy Name | Assistive Technology Supplier Audiologist
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License Number | 109
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 109
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 109
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License Number State | CT
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