Provider Demographics
NPI:1710666904
Name:MASSA, MIKAYLA LEEANN (AUD)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:LEEANN
Last Name:MASSA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:LEEANN
Other - Last Name:BAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:884 S CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8006
Mailing Address - Country:US
Mailing Address - Phone:304-671-4010
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1191
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02467231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist