Provider Demographics
NPI:1063545168
Name:SPUDIE, ANNETTE M
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:M
Last Name:SPUDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:419-882-5000
Mailing Address - Fax:419-882-5008
Practice Address - Street 1:5151 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-882-5000
Practice Address - Fax:419-882-5008
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00615231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00446992Medicare PIN
OHSP4204561Medicare PIN
OHSP4204563Medicare PIN