Provider Demographics
NPI:1881243418
Name:POWER, IAN H (MCLSC (SLP))
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:H
Last Name:POWER
Suffix:
Gender:M
Credentials:MCLSC (SLP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6698
Mailing Address - Country:US
Mailing Address - Phone:203-594-5200
Mailing Address - Fax:
Practice Address - Street 1:3 FARM RD
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-6698
Practice Address - Country:US
Practice Address - Phone:203-594-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5775235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5775OtherSTATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH