Individual
ELYSE KIRSCHBLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CCC-A
Contact information
Practice address
36 WATSON ST, WILLIMANTIC, CT 06226-2122
(860) 456-0287
(860) 456-3532
Mailing address
79 WAWECUS ST, NORWICH, CT 06360-2160
(860) 886-6610
(860) 886-6664
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
000208
CT
237600000X
Audiologist-Hearing Aid Fitter
000208
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316015464
—
CT
Enumeration date
11/30/2006
Last updated
02/22/2018
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