Provider Demographics
NPI:1912343997
Name:VISE, LAYLA (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:LAYLA
Middle Name:
Last Name:VISE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6531
Mailing Address - Country:US
Mailing Address - Phone:937-912-9579
Mailing Address - Fax:
Practice Address - Street 1:6281 TRI RIDGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8345
Practice Address - Country:US
Practice Address - Phone:866-791-5766
Practice Address - Fax:877-794-3289
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10286235Z00000X
FLSA 8413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist