Provider Demographics
NPI:1366505695
Name:FLICK, JANET LOUISE (MA F AAA)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:LOUISE
Last Name:FLICK
Suffix:
Gender:F
Credentials:MA F AAA
Other - Prefix:MRS
Other - First Name:JANET
Other - Middle Name:LOUISE
Other - Last Name:REITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC A
Mailing Address - Street 1:4720 WILMINTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-2021
Mailing Address - Country:US
Mailing Address - Phone:937-435-5033
Mailing Address - Fax:937-435-5512
Practice Address - Street 1:4720 WILMINTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-2021
Practice Address - Country:US
Practice Address - Phone:937-435-5033
Practice Address - Fax:937-435-5512
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00305237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0494335Medicaid
000000206673OtherANTHEM
000000275569OtherANTHEM
RE4050991Medicare ID - Type Unspecified