Provider Demographics
NPI:1912337601
Name:MALGRANDE, CONNIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:MALGRANDE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:TWOMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 NORTH ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5660
Mailing Address - Country:US
Mailing Address - Phone:203-792-0400
Mailing Address - Fax:203-792-0404
Practice Address - Street 1:57 NORTH ST
Practice Address - Street 2:SUITE 218
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5660
Practice Address - Country:US
Practice Address - Phone:203-792-0400
Practice Address - Fax:203-792-0404
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist