Provider Demographics
NPI:1952631533
Name:EWELL, COURTNEY A (AUD, ABA-CERT)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:A
Last Name:EWELL
Suffix:
Gender:F
Credentials:AUD, ABA-CERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010
Mailing Address - Country:US
Mailing Address - Phone:714-639-4990
Mailing Address - Fax:
Practice Address - Street 1:440 N MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-893-1977
Practice Address - Fax:860-845-5330
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2652231H00000X
237600000X
CT000524231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008126225Medicaid