Stephanie L. Bakewell, AUDIOLOGIST
Individual provider Active NPI Audiologist · Southbury, CT
NPI 1659628931 · NPPES record last updated Sep 15, 2016
Key facts
- NPI
- 1659628931
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- 523 (CT)
- Practice address
- 2 Pomperaug Office Park
Suite 307
Southbury, CT 06488 - Phone
- (203) 264-8201
- Fax
- (203) 264-8201
- NPI assigned
- Aug 6, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Qualified Audiologist
- Education
- University of Connecticut School of Medicine, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southbury Audiology LLC
Practice addresses (Care Compare)
2 Pomperaug Office Park
Suite 307
Southbury, CT 06488-2293
Phone (203) 264-8201
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121001000217 | CT | Practitioner - Qualified Audiologist | 9830348291 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southbury Audiology LLC | Audiologist | Current |
Accepting new patients |
Locations
800 Main St S
Ste 102
Southbury, CT 06488
2 Pomperaug Office Park
Ste 307
Southbury, CT 06488
Phone (203) 264-8201
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 523 | CT | Yes |
Addresses
Primary practice location
2 Pomperaug Office Park
Suite 307
Southbury, CT 06488
Mailing address
249 Smith Rd
Provider Enrollment
Thomaston, CT 06787-1234
Phone (203) 228-6380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659628931 | Medicaid | CT |
Other names
- Stephanie L Woodruff
Other providers in Southbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.