Provider Demographics
NPI:1578965976
Name:VERVILLE, JOANN
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:VERVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOANN VERVILLE
Other - Middle Name:
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:306 KATIEBUD DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5100
Mailing Address - Country:US
Mailing Address - Phone:513-363-5335
Mailing Address - Fax:513-363-5340
Practice Address - Street 1:5425 WINTON RIDGE LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45232-1140
Practice Address - Country:US
Practice Address - Phone:513-363-5335
Practice Address - Fax:513-363-5340
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.4816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist