Individual
STEPHANIE L. BAKEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUDIOLOGIST
Contact information
Practice address
2 POMPERAUG OFFICE PARK, SUITE 307, SOUTHBURY, CT 06488
(203) 264-8201
(203) 264-8201
Mailing address
249 SMITH RD, PROVIDER ENROLLMENT, THOMASTON, CT 06787-1234
(203) 228-6380
(203) 264-8201
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
523
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659628931
—
CT
Enumeration date
08/06/2012
Last updated
09/15/2016
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