Provider Demographics
NPI:1497850499
Name:STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Entity Type:Organization
Organization Name:STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
Other - Org Name:URI SPEECH AND HEARING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR/ASSISTANT PROFESSOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:401-874-4741
Mailing Address - Street 1:25 W INDEPENDENCE WAY STE I
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02881-1124
Mailing Address - Country:US
Mailing Address - Phone:401-874-9387
Mailing Address - Fax:
Practice Address - Street 1:25 W INDEPENDENCE WAY STE I
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1124
Practice Address - Country:US
Practice Address - Phone:401-874-9387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI649002626Medicare UPIN