Provider Demographics
NPI:1821110008
Name:BGSU SPEECH AND HEARING CLINIC
Entity Type:Organization
Organization Name:BGSU SPEECH AND HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE PROFESSOR AND CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:419-372-2515
Mailing Address - Street 1:200 HEALTH CTR
Mailing Address - Street 2:BOWLING GREEN STATE UNIVERSITY
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43403-0149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 HEALTH CTR
Practice Address - Street 2:BOWLING GREEN STATE UNIVERSITY
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43403-0149
Practice Address - Country:US
Practice Address - Phone:419-372-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0576523Medicaid
OHBO9355221Medicare ID - Type UnspecifiedMEDICARE