Provider Demographics
NPI:1023004579
Name:NADLER, ALEXIS R (AUD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:R
Last Name:NADLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W MARKET ST
Mailing Address - Street 2:SUITE 333
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4761
Mailing Address - Country:US
Mailing Address - Phone:419-222-9010
Mailing Address - Fax:419-222-5496
Practice Address - Street 1:545 W MARKET ST
Practice Address - Street 2:SUITE 333
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4761
Practice Address - Country:US
Practice Address - Phone:419-222-9010
Practice Address - Fax:419-222-5496
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00653231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2458335Medicaid
OH2458335Medicaid