Provider Demographics
NPI:1821255076
Name:O'HEARN, VICTORIA MOLUSE (MS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MOLUSE
Last Name:O'HEARN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-246-7796
Mailing Address - Fax:513-852-8525
Practice Address - Street 1:8040 PRINCETON-GLENDALE RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-0000
Practice Address - Country:US
Practice Address - Phone:513-246-7000
Practice Address - Fax:513-246-5479
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.0360231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA-0360OtherLICENSE