Provider Demographics
NPI:1891836714
Name:RUDY, JANE H (AUD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:H
Last Name:RUDY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3016
Mailing Address - Country:US
Mailing Address - Phone:937-308-7000
Mailing Address - Fax:
Practice Address - Street 1:520 S RIDGE AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3016
Practice Address - Country:US
Practice Address - Phone:937-308-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-00421237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0754296Medicaid
OH0754296Medicaid