Provider Demographics
NPI:1194834143
Name:WALTER WOLOSIANSKY
Entity Type:Organization
Organization Name:WALTER WOLOSIANSKY
Other - Org Name:COMMUNITY HEARING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AUDIOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOLOSIANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC A
Authorized Official - Phone:330-896-9119
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:44232-0667
Mailing Address - Country:US
Mailing Address - Phone:330-896-9119
Mailing Address - Fax:330-896-1185
Practice Address - Street 1:4700 MASSILLON RD
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-1166
Practice Address - Country:US
Practice Address - Phone:330-896-9119
Practice Address - Fax:330-896-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00655231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH062466314001OtherMEDICAL MUTUAL OF OHIO
OH000000136008OtherANTHEM BCBS
OH7858279OtherAETNA
OH0793619Medicaid