Provider Demographics
NPI:1639828676
Name:KOLIAS, ALEXA HAZEL (AUD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:HAZEL
Last Name:KOLIAS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 CHAPEL ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-7409
Mailing Address - Country:US
Mailing Address - Phone:847-809-8092
Mailing Address - Fax:
Practice Address - Street 1:141 TROUT AVE
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349
Practice Address - Country:US
Practice Address - Phone:860-694-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17.000662237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
14382182OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
CT17.000662OtherDEPARTMENT OF PUBLIC HEALTH PRACTITIONER LICENSING AND INVESTIGATIONS SECTION