Provider Demographics
NPI:1770747289
Name:STAGNITTI, CHARLES DOMINICK (MS CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:DOMINICK
Last Name:STAGNITTI
Suffix:
Gender:M
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 W BASS LN
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1955
Mailing Address - Country:US
Mailing Address - Phone:860-668-1948
Mailing Address - Fax:
Practice Address - Street 1:601 RIVER ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1325
Practice Address - Country:US
Practice Address - Phone:860-298-9079
Practice Address - Fax:860-298-8413
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0081827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist