Provider Demographics
NPI:1760949325
Name:WELLINGHOFF, ALICIA (HAS)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WELLINGHOFF
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2559
Mailing Address - Country:US
Mailing Address - Phone:937-260-8581
Mailing Address - Fax:
Practice Address - Street 1:1111 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-6713
Practice Address - Country:US
Practice Address - Phone:937-356-6741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03308237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist