Provider Demographics
NPI:1114011830
Name:UNIVERSITY OF CONNECTICUT
Entity Type:Organization
Organization Name:UNIVERSITY OF CONNECTICUT
Other - Org Name:UNIVERSITY OF CONNECTICUT SPEECH & HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:860-486-2629
Mailing Address - Street 1:2 ALETHIA DR # U-1085
Mailing Address - Street 2:
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-1085
Mailing Address - Country:US
Mailing Address - Phone:860-486-2629
Mailing Address - Fax:860-486-4948
Practice Address - Street 1:2 ALETHIA DR # U-1085
Practice Address - Street 2:
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-1085
Practice Address - Country:US
Practice Address - Phone:860-486-2629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CONNECTICUT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 231HA2500X, 235500000X, 235Z00000X
CT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty