Provider Demographics
NPI:1033380621
Name:FAIS, MARY BETH (AUD)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:FAIS
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 1:974 BETHEL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2467
Mailing Address - Country:US
Mailing Address - Phone:614-538-2424
Mailing Address - Fax:614-538-2418
Practice Address - Street 1:1810 MACKENZIE DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2967
Practice Address - Country:US
Practice Address - Phone:614-273-2250
Practice Address - Fax:614-273-2255
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0224231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist