Provider Demographics
NPI:1144737784
Name:WIDENMEYER, BEN
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:WIDENMEYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 MEDINA RD STE 118
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8153
Mailing Address - Country:US
Mailing Address - Phone:330-723-2304
Mailing Address - Fax:330-723-2395
Practice Address - Street 1:3637 MEDINA RD STE 118
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8153
Practice Address - Country:US
Practice Address - Phone:330-723-2304
Practice Address - Fax:330-723-2395
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2991237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist