Provider Demographics
NPI:1477040418
Name:KUSHCH, CONNIE ANNE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ANNE
Last Name:KUSHCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 N ABIACA CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7126
Mailing Address - Country:US
Mailing Address - Phone:954-562-3274
Mailing Address - Fax:954-533-1937
Practice Address - Street 1:5353 N FEDERAL HWY STE 207
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3236
Practice Address - Country:US
Practice Address - Phone:954-562-3274
Practice Address - Fax:954-533-1937
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY119231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist