Provider Demographics
NPI:1235551631
Name:FIRESTONE, DENISE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FITCH BLVD UNIT 281
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2246
Mailing Address - Country:US
Mailing Address - Phone:330-565-4614
Mailing Address - Fax:
Practice Address - Street 1:880 E INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2370
Practice Address - Country:US
Practice Address - Phone:330-788-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3553235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist