Provider Demographics
NPI:1063761757
Name:MCCONNELL, KEVIN L (HAP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:HAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E. SUNSET ROAD
Mailing Address - Street 2:UNIT 96595
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89193-1246
Mailing Address - Country:US
Mailing Address - Phone:702-798-0113
Mailing Address - Fax:866-291-5242
Practice Address - Street 1:12510 E ILIFF AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6376
Practice Address - Country:US
Practice Address - Phone:303-745-1431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000219237700000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist