Provider Demographics
NPI:1083030308
Name:OFFENBACH, EFFRAT P (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EFFRAT
Middle Name:P
Last Name:OFFENBACH
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N ROSE BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1060
Mailing Address - Country:US
Mailing Address - Phone:908-208-9328
Mailing Address - Fax:
Practice Address - Street 1:14411 JUSTICE RD STE C
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6907
Practice Address - Country:US
Practice Address - Phone:804-794-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008390235Z00000X
OHCOND 2013318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2202008390OtherVA SLP LICENSE
OHCOND 2013318OtherOHIO BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY