Provider Demographics
NPI:1780977603
Name:SOUND AUDIOLOGY AND HEARING AID CENTER LLC
Entity type:Organization
Organization Name:SOUND AUDIOLOGY AND HEARING AID CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:RYANS
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, MS, CCC/A
Authorized Official - Phone:860-495-5582
Mailing Address - Street 1:82 NORWICH WESTERLY RD
Mailing Address - Street 2:BOX #6
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-1744
Mailing Address - Country:US
Mailing Address - Phone:860-495-5582
Mailing Address - Fax:
Practice Address - Street 1:82 NORWICH WESTERLY RD
Practice Address - Street 2:BOX #6
Practice Address - City:NORTH STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-1744
Practice Address - Country:US
Practice Address - Phone:860-495-5582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000289261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech