Donna Marie Blain, M.A., CCC-A
Individual provider Active NPI Audiologist · West Hartford, CT
NPI 1780904185 · NPPES record last updated Jun 8, 2010
Key facts
- NPI
- 1780904185
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Audiologist 231H00000X
- License
- 000264 (CT)
- Practice address
- 139 N Main St
West Hartford, CT 06107-1264 - Phone
- (860) 557-2227
- Fax
- (860) 570-2227
- NPI assigned
- Jun 8, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000264 | CT | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Early Childhood Service - American School for the Deaf | Past |
Accepting new patients | |
| American School for the Deaf | Audiologist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 000264 | CT | Yes |
| Assistive Technology Practitioner Audiologist | 231HA2400X | 000264 | CT | |
| Assistive Technology Supplier Audiologist | 231HA2500X | 000264 | CT | |
| Audiologist-Hearing Aid Fitter | 237600000X | 000264 | CT |
Addresses
Primary practice location
139 N Main St
West Hartford, CT 06107-1264
Mailing address
139 N Main St
West Hartford, CT 06107-1264
Phone (860) 557-2227
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004170726 | Medicaid | CT |
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All providers in West Hartford, CT · Audiologist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.