ROBERT W BALLOUGH (Credential# 743828) is licensed (Physician Assistant) with Connecticut Department of Consumer Protection. The license effective date is May 1, 2020. The license expiration date date is April 30, 2021. The license status is ACTIVE.
ROBERT W BALLOUGH is licensed with the Department of Consumer Protection of Connecticut. The credential number is #23.002079. The credential type is physician assistant. The effective date is May 1, 2020. The expiration date is April 30, 2021. The business address is 4 Farm Court, Wallingford, CT 06492-2100. The current status is active.
| Licensee Name | ROBERT W BALLOUGH |
| Credential ID | 743828 |
| Credential Number | 23.002079 |
| Credential Type | Physician Assistant |
| Business Address |
4 Farm Court Wallingford CT 06492-2100 |
| Business Type | INDIVIDUAL |
| Status | ACTIVE - CURRENT |
| Active | 1 |
| Issue Date | 2008-02-26 |
| Effective Date | 2020-05-01 |
| Expiration Date | 2021-04-30 |
| Refresh Date | 2020-03-24 |
| ID | Credential Code | Credential Type | Issue | Term | Status |
|---|---|---|---|---|---|
| 504287 | CSP.0043588 | CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONER | 2008-05-29 | 2019-03-01 - 2021-02-28 | ACTIVE |
| Street Address | 4 FARM COURT |
| City | WALLINGFORD |
| State | CT |
| Zip Code | 06492-2100 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Caroline R Regan | 4 Farm Court, Wallingford, CT 06492 | Notary Public Appointment | 2012-04-01 ~ 2017-03-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Paul A Judenis | 123 Ridgewood Rd, Wallingford, CT 06492-2100 | Emergency Medical Technician | 2019-10-01 ~ 2022-09-30 |
| Alyssa C Gade | 145 Ridgewood Rd, Wallingford, CT 06492-2100 | Radiographer | 2019-09-01 ~ 2020-08-31 |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Andrea Zola | 53 Alison Ave., Wallingford, CT 06492 | Esthetician | ~ |
| Kyungok Choi | 90 Ward St, Wallingford, CT 06492 | Combination Nail Technician, Esthetician Or Eyelash Technici | ~ |
| Giang Nguyen | 45 Country Club Lane, Wallingford, CT 06492 | Combination Nail Technician, Esthetician Or Eyelash Technici | 2020-06-27 ~ 2021-11-30 |
| Lc Artistry | 207 North Colony Road, Wallingford, CT 06492 | Esthetician | ~ |
| Katie Lee | 20 Angela Dr, Wallingford, CT 06492 | Paramedic | 2020-09-01 ~ 2021-08-31 |
| Vinny's Deli | 567 Center St, Wallingford, CT 06492 | Operator of Weighing & Measuring Devices | 2020-08-01 ~ 2021-07-31 |
| Michele Ruggiero | 26 Leigus Road, Wallingford, CT 06492 | Radiographer | 2020-07-01 ~ 2021-06-30 |
| Dianna K Ball | 104 Simpson Ave, Wallingford, CT 06492 | Speech and Language Pathologist | 2020-08-01 ~ 2021-07-31 |
| Ann Marie Richardson | 20 Mohawk Drive, Wallingford, CT 06492 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
| Joann Hummel | 60 Deer Run Road, Wallingford, CT 06492 | Medication Administration Certification | 2018-08-21 ~ 2020-08-20 |
| Find all Licenses in zip 06492 | |||
| City | WALLINGFORD |
| Zip Code | 06492 |
| License Type | Physician Assistant |
| License Type + County | Physician Assistant + WALLINGFORD |
| Licensee Name | Office Address | Credential | Effective / Expiration |
|---|---|---|---|
| Robert Ficara Pa | 30 Farm Lea Dr, Somers, CT 06071-1117 | Physician Assistant | 2020-05-01 ~ 2021-04-30 |
| Robert J Alfiero Pa | 2 Champion St, Westerly, RI 02891 | Physician Assistant | 2004-06-14 ~ 2005-05-31 |
| Robert J Kupis | 107 Pennsylvania Ave, Niantic, CT 06357-2509 | Physician Assistant | 2020-03-01 ~ 2021-02-28 |
| Robert Greco Pa | 12 Sand Rd, New Milford, CT 06770 | Physician Assistant | 2020-07-01 ~ 2021-06-30 |
| Adam Robert Sokolowski | 35 Sylvia Ct, Plantsville, CT 06479-1322 | Physician Assistant | ~ |
| Robert J Brice | 124 Simpson Ave, Wallingford, CT 06492 | Physician Assistant | 2020-06-01 ~ 2021-05-31 |
| Robert L Bligh Jr. | 23 Cortland Way, Newington, CT 06111 | Physician Assistant | 2020-04-01 ~ 2021-03-31 |
| Robert Silva | 721 N Liberty Dr Fl 2, Tomkins Cove, NY 10986-1709 | Physician Assistant | 2020-06-24 ~ 2021-01-31 |
| Robert Young | 18 Golden Hill Rd, Danbury, CT 06811 | Physician Assistant | 2007-11-26 ~ 2008-11-30 |
| Robert R Hoffner | 1091 Beswick Way, Ashland, OR 97520-3575 | Physician Assistant | 2013-06-01 ~ 2014-05-31 |
Please comment or provide details below to improve the information on ROBERT W BALLOUGH.
| Data Provider | Connecticut Department of Consumer Protection |
| Jurisdiction | Connecticut |
| Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).