Provider Demographics
NPI:1457785701
Name:CONLON, PATRICK J (HAS, BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:CONLON
Suffix:
Gender:M
Credentials:HAS, BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 AVENUE K SE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4125
Mailing Address - Country:US
Mailing Address - Phone:863-294-8353
Mailing Address - Fax:863-299-0334
Practice Address - Street 1:490 AVENUE K SE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4125
Practice Address - Country:US
Practice Address - Phone:863-294-8353
Practice Address - Fax:863-299-0334
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS1699237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
07878OtherHEARUSA
FL085215500Medicaid
J0507OtherBC/BS INSURANCE