Provider Demographics
NPI:1245052430
Name:COLE, ADDALYN RENEE (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:ADDALYN
Middle Name:RENEE
Last Name:COLE
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1700
Mailing Address - Country:US
Mailing Address - Phone:937-578-7200
Mailing Address - Fax:
Practice Address - Street 1:21511 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:OH
Practice Address - Zip Code:43067-9721
Practice Address - Country:US
Practice Address - Phone:937-578-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20242939-SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist