Provider Demographics
NPI:1376089730
Name:WOLOSIANSKY, WALTER B
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:B
Last Name:WOLOSIANSKY
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00655231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist