Provider Demographics
NPI:1891891222
Name:BIRKENBUEL, SHARON KAYE (MACCCSLP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAYE
Last Name:BIRKENBUEL
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 DRESDEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756
Mailing Address - Country:US
Mailing Address - Phone:860-491-3371
Mailing Address - Fax:
Practice Address - Street 1:733 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790
Practice Address - Country:US
Practice Address - Phone:860-496-7246
Practice Address - Fax:860-496-0553
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist