Provider Demographics
NPI:1619012101
Name:NORTHWEST OHIO SPEECH LANGUAGE AND
Entity Type:Organization
Organization Name:NORTHWEST OHIO SPEECH LANGUAGE AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-536-4247
Mailing Address - Street 1:3450 W CENTRAL AVE
Mailing Address - Street 2:SUITE 336
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1416
Mailing Address - Country:US
Mailing Address - Phone:419-536-4247
Mailing Address - Fax:
Practice Address - Street 1:3450 W CENTRAL AVE
Practice Address - Street 2:SUITE 336
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1416
Practice Address - Country:US
Practice Address - Phone:419-536-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
02255OtherPARAMOUNT
OH2009258Medicaid
02255OtherPARAMOUNT