Provider Demographics
NPI:1518320134
Name:VASH, JOHN (HIS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:VASH
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 VALLEY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-7259
Mailing Address - Country:US
Mailing Address - Phone:304-476-7503
Mailing Address - Fax:304-842-1060
Practice Address - Street 1:162 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-8104
Practice Address - Country:US
Practice Address - Phone:304-210-8118
Practice Address - Fax:304-842-1060
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2017-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV950237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist