Provider Demographics
NPI:1669508347
Name:FAMILY SPEECH & HEARING CLINIC, LLC
Entity type:Organization
Organization Name:FAMILY SPEECH & HEARING CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SENTELIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-791-1458
Mailing Address - Street 1:6642 BRANCH HILL GUINEA PIKE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9178
Mailing Address - Country:US
Mailing Address - Phone:513-791-1458
Mailing Address - Fax:513-791-4326
Practice Address - Street 1:6642 BRANCH HILL GUINEA PIKE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9178
Practice Address - Country:US
Practice Address - Phone:513-791-1458
Practice Address - Fax:513-791-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0142368Medicaid