Provider Demographics
NPI:1790785905
Name:HANS, JAY CLARK (AUD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:CLARK
Last Name:HANS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 COACHMAN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1305
Mailing Address - Country:US
Mailing Address - Phone:860-464-9779
Mailing Address - Fax:
Practice Address - Street 1:7 COACHMAN PIKE
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1305
Practice Address - Country:US
Practice Address - Phone:860-464-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT122231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist