Provider Demographics
NPI:1518920651
Name:DEWINE, LAURIE (MA,CCC-A)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:DEWINE
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-5133
Mailing Address - Country:US
Mailing Address - Phone:513-922-0123
Mailing Address - Fax:513-922-3572
Practice Address - Street 1:3302 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5133
Practice Address - Country:US
Practice Address - Phone:513-922-0123
Practice Address - Fax:513-922-3572
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH318231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPL9350991OtherGROUP PIN
OHPL9350991OtherGROUP PIN