MEDICARE: DR. JAY CLARK HANS AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	122	CT

General Provider Information

NPI Number	:	1790785905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY CLARK HANS AU.D.

Provider Business Mailing Address
First Line	:	7 COACHMAN PIKE
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1305
Country	:	US
Telephone Number	:	860-464-9779
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 COACHMAN PIKE
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1305
Country	:	US
Telephone Number	:	860-464-9779
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	06/21/2010

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