Provider Demographics
NPI:1508088113
Name:KENWOOD HEARING CENTER INC
Entity Type:Organization
Organization Name:KENWOOD HEARING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINKER JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA-CCA
Authorized Official - Phone:419-534-3111
Mailing Address - Street 1:3450 W CENTRAL AVE STE 134
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1403
Mailing Address - Country:US
Mailing Address - Phone:419-534-3111
Mailing Address - Fax:419-534-3113
Practice Address - Street 1:725 S SHOOP AVE
Practice Address - Street 2:FULTON COUNTY HEALTH CENTER MOB
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567
Practice Address - Country:US
Practice Address - Phone:419-534-3111
Practice Address - Fax:419-534-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKE9304872Medicare ID - Type UnspecifiedAUDIOLOGIST