Provider Demographics
NPI:1922308899
Name:GOLLA, MARIA ELLEN (MSP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELLEN
Last Name:GOLLA
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PIEDMONT AVE
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-4231
Mailing Address - Country:US
Mailing Address - Phone:513-475-8400
Mailing Address - Fax:513-475-8228
Practice Address - Street 1:7700 UNIVERSITY CT
Practice Address - Street 2:SUITE 3900
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-6542
Practice Address - Country:US
Practice Address - Phone:513-475-8400
Practice Address - Fax:513-475-8271
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2011151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist