Provider Demographics
NPI:1093385510
Name:MERRY, CAROLYN ZAITZEW (AUD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ZAITZEW
Last Name:MERRY
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 1:2905 AUTUMNWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2860
Mailing Address - Country:US
Mailing Address - Phone:330-330-0877
Mailing Address - Fax:
Practice Address - Street 1:126 YORK AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5615
Practice Address - Country:US
Practice Address - Phone:330-726-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02328231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist