Provider Demographics
NPI:1437686896
Name:HULETT, MATTIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MATTIE
Middle Name:
Last Name:HULETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 LIBERTY SQ APT 280
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-5422
Mailing Address - Country:US
Mailing Address - Phone:513-319-8825
Mailing Address - Fax:
Practice Address - Street 1:1268 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3043
Practice Address - Country:US
Practice Address - Phone:860-216-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist