Provider Demographics
NPI:1215380068
Name:PIE, ELISE (BS)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:PIE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 SUN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2733
Mailing Address - Country:US
Mailing Address - Phone:860-817-5506
Mailing Address - Fax:
Practice Address - Street 1:166 SUN VALLEY DR
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2733
Practice Address - Country:US
Practice Address - Phone:860-817-5506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT429237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist