Provider Demographics
NPI:1093266736
Name:KIBELBEK, ANDREW HARTER (AUD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:HARTER
Last Name:KIBELBEK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 S PATTERSON BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2642
Mailing Address - Country:US
Mailing Address - Phone:937-496-2620
Mailing Address - Fax:937-424-8518
Practice Address - Street 1:6601 CENTERVILLE BUSINESS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-2691
Practice Address - Country:US
Practice Address - Phone:937-496-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02034231H00000X, 231HA2400X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter