Provider Demographics
NPI:1679624928
Name:KAIRES, PATTI (MA CCC AUD)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:KAIRES
Suffix:
Gender:F
Credentials:MA CCC AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST STE 700
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:419-824-1444
Mailing Address - Fax:419-824-1743
Practice Address - Street 1:5200 HARROUN RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2168
Practice Address - Country:US
Practice Address - Phone:419-824-1444
Practice Address - Fax:419-824-1743
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00773231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06751OtherPARAMOUNT
PENDINGOtherHEALTH NET TRICARE
MI5187323Medicaid
OHPENDINGOtherAETNA
PENDINGOtherHEALTH NET TRICARE