Provider Demographics
NPI:1912354507
Name:DOYLE, AVERY (MS, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:AVERY
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MS
Other - First Name:AVERY
Other - Middle Name:
Other - Last Name:CHUCTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:230 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1916
Mailing Address - Country:US
Mailing Address - Phone:860-674-1824
Mailing Address - Fax:
Practice Address - Street 1:230 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1916
Practice Address - Country:US
Practice Address - Phone:860-674-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist