Provider Demographics
NPI:1063947190
Name:CONNIE KUSHCH AU.D., LLC
Entity type:Organization
Organization Name:CONNIE KUSHCH AU.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KUSHCH
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:954-562-3274
Mailing Address - Street 1:9900 N ABIACA CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7126
Mailing Address - Country:US
Mailing Address - Phone:954-472-8921
Mailing Address - Fax:954-533-1937
Practice Address - Street 1:5353 N FEDERAL HWY
Practice Address - Street 2:SUITE 207
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3245
Practice Address - Country:US
Practice Address - Phone:954-562-3274
Practice Address - Fax:954-533-1937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY119231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty