Provider Demographics
NPI:1184181406
Name:HAIRE, CAROL ANN (SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:HAIRE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1036
Mailing Address - Country:US
Mailing Address - Phone:860-430-1340
Mailing Address - Fax:860-812-2399
Practice Address - Street 1:2800 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1036
Practice Address - Country:US
Practice Address - Phone:860-430-1340
Practice Address - Fax:860-812-2300
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist