Basic Information
Provider Information | |||||||||
NPI: | 1013249895 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCLAUGHLIN | ||||||||
FirstName: | PAULA | ||||||||
MiddleName: | KAY | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.S., CCC-A | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BRANDELL | ||||||||
OtherFirstName: | PAULA | ||||||||
OtherMiddleName: | KAY | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.S., CCC-A | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 888 WORCESTER ST | ||||||||
Address2: | SUITE 130 | ||||||||
City: | WELLESLEY | ||||||||
State: | MA | ||||||||
PostalCode: | 024823744 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6179646681 | ||||||||
FaxNumber: | 3396862561 | ||||||||
Practice Location | |||||||||
Address1: | 438 MAIN ST | ||||||||
Address2: | SUITE 204 | ||||||||
City: | MIDDLETOWN | ||||||||
State: | CT | ||||||||
PostalCode: | 064573396 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8889646681 | ||||||||
FaxNumber: | 8886620859 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/04/2010 | ||||||||
LastUpdateDate: | 10/24/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 000267 | CT | Y |   | Speech, Language and Hearing Service Providers | Audiologist |   | 231H00000X | 977 | MA | N |   | Speech, Language and Hearing Service Providers | Audiologist |   | 231H00000X | AUD00200 | RI | N |   | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.