Individual
DR. CAROL HELEN KISNER-BOTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
1 PRESTIGE DR, SUITE 107, MERIDEN, CT 06450-7164
(203) 639-0311
(203) 639-1489
Mailing address
25 NEEDHAM ST, NEWTON, MA 02461-1615
(617) 964-6681
(617) 630-0141
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
000203
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
730000203CT04
BLUE CROSS BLUE SHIELD
CT
Enumeration date
08/05/2006
Last updated
07/08/2007
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