Provider Demographics
NPI:1710048111
Name:ALEX, CATHLEEN ANNE (AUD)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ANNE
Last Name:ALEX
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 1:2 POMPERAUG OFFICE PARK
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2288
Mailing Address - Country:US
Mailing Address - Phone:203-264-8201
Mailing Address - Fax:203-264-8201
Practice Address - Street 1:2 POMPERAUG OFFICE PARK
Practice Address - Street 2:SUITE 307
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2288
Practice Address - Country:US
Practice Address - Phone:203-264-8201
Practice Address - Fax:203-264-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT109237600000X, 231H00000X, 231HA2400X, 231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4048674Medicaid
CT001376523-001OtherUNITED HEALTH CARE
CT724745OtherCONNECTICARE
CT0123218OtherAETNA
CT730000109CT01OtherANTHEM BCBS
CTOR2817OtherHEALTH NET
CTP442727OtherOXFORD
CT4048864Medicaid
CTP442727OtherOXFORD