Provider Demographics
NPI:1942414503
Name:MATHEWS, RONNI ELLEN (MS, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:RONNI
Middle Name:ELLEN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PONDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-3948
Mailing Address - Country:US
Mailing Address - Phone:860-378-0288
Mailing Address - Fax:
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2517
Practice Address - Country:US
Practice Address - Phone:203-753-8833
Practice Address - Fax:203-753-3744
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000381231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist