Provider Demographics
NPI:1689563819
Name:SIMON, NOEL ERIK
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:ERIK
Last Name:SIMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 DAWNRIDGE RD SE
Mailing Address - Street 2:
Mailing Address - City:EAST SPARTA
Mailing Address - State:OH
Mailing Address - Zip Code:44626-9790
Mailing Address - Country:US
Mailing Address - Phone:716-220-7432
Mailing Address - Fax:
Practice Address - Street 1:1366 DAWNRIDGE RD SE
Practice Address - Street 2:
Practice Address - City:EAST SPARTA
Practice Address - State:OH
Practice Address - Zip Code:44626-9790
Practice Address - Country:US
Practice Address - Phone:716-220-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP14148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist