Provider Demographics
NPI:1477683795
Name:STANKIEWICZ, ERIN WORGUL (AUD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:WORGUL
Last Name:STANKIEWICZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:WORGUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:167 PARKWAY N
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1200
Mailing Address - Country:US
Mailing Address - Phone:860-443-6944
Mailing Address - Fax:860-442-7906
Practice Address - Street 1:167 PARKWAY N
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1200
Practice Address - Country:US
Practice Address - Phone:860-443-6944
Practice Address - Fax:860-442-7906
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT441231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT730000441CT05OtherANTHEM
CT2V6031OtherHEALTHNET
CT3932493OtherAETNA HMO
CT111441OtherCONNECTICARE
CT7561669OtherAETNA PPO
CT2V6031OtherHEALTHNET