Provider Demographics
NPI:1396957163
Name:HOROWITZ, WILLA C (AUD, CCC-A, FAAA)
Entity type:Individual
Prefix:DR
First Name:WILLA
Middle Name:C
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:AUD, CCC-A, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MOUNT SANFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-1210
Mailing Address - Country:US
Mailing Address - Phone:203-640-2198
Mailing Address - Fax:
Practice Address - Street 1:130 MOUNT SANFORD ROAD
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-1210
Practice Address - Country:US
Practice Address - Phone:203-640-2198
Practice Address - Fax:203-287-9781
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000127237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4899970OtherGHI
CT4174174Medicaid
CT4899970OtherGHI