Provider Demographics
NPI:1376943308
Name:CANTWELL, BARBARA
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 OAK KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1364
Mailing Address - Country:US
Mailing Address - Phone:937-293-4518
Mailing Address - Fax:
Practice Address - Street 1:2660 DAYTON-XENIA RD
Practice Address - Street 2:BEAVERCREEK HIGH SCHOOL
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434
Practice Address - Country:US
Practice Address - Phone:937-429-7547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 6145235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist