Provider Demographics
NPI:1144007907
Name:CALLAHAN, JONATHAN NOLAN (HIS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NOLAN
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3952
Mailing Address - Country:US
Mailing Address - Phone:413-237-0790
Mailing Address - Fax:
Practice Address - Street 1:728 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3952
Practice Address - Country:US
Practice Address - Phone:413-237-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000487237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist