Provider Demographics
NPI:1740895408
Name:FITZGERALD, CAROLINE (SLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:ZETTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11230 CORNELL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-1825
Mailing Address - Country:US
Mailing Address - Phone:513-880-6800
Mailing Address - Fax:
Practice Address - Street 1:11230 CORNELL PARK DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-1825
Practice Address - Country:US
Practice Address - Phone:513-880-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20201326235Z00000X
OHSP.14541235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0470907Medicaid