Provider Demographics
NPI:1194030478
Name:BLANCHETTE, MEGAN MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:BLANCHETTE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:MARIE
Other - Last Name:ENGRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:160 WEST ST
Mailing Address - Street 2:STE B
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2441
Mailing Address - Country:US
Mailing Address - Phone:860-657-2286
Mailing Address - Fax:860-657-2573
Practice Address - Street 1:799 HEBRON AVE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2451
Practice Address - Country:US
Practice Address - Phone:860-657-2286
Practice Address - Fax:860-657-2573
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000494231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist