Provider Demographics
NPI:1093869125
Name:SPEECH & LANGUAGE ASSOC. OF GREATER CINTI.
Entity Type:Organization
Organization Name:SPEECH & LANGUAGE ASSOC. OF GREATER CINTI.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CREAGHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:513-221-4243
Mailing Address - Street 1:2651 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2301
Mailing Address - Country:US
Mailing Address - Phone:513-221-4243
Mailing Address - Fax:513-221-5924
Practice Address - Street 1:2651 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2301
Practice Address - Country:US
Practice Address - Phone:513-221-4243
Practice Address - Fax:513-221-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP0740235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2290364Medicaid
OH=========040OtherCARESOURCE