Provider Demographics
NPI:1679606651
Name:HUTTNER, SHARON G (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:G
Last Name:HUTTNER
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 1:60 CONNOLLY PKWY
Mailing Address - Street 2:BLDG. 17
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2593
Mailing Address - Country:US
Mailing Address - Phone:203-230-2815
Mailing Address - Fax:203-230-8502
Practice Address - Street 1:60 CONNOLLY PKWY
Practice Address - Street 2:BLDG. 17
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-230-2815
Practice Address - Fax:203-230-8502
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000419235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0000419OtherLICENSE #