Provider Demographics
NPI:1124277835
Name:DANNEMILLER-SMITH, KRISTIE MARIE (AUD)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:MARIE
Last Name:DANNEMILLER-SMITH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 ROBINSON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-3659
Mailing Address - Country:US
Mailing Address - Phone:330-734-6360
Mailing Address - Fax:330-734-6363
Practice Address - Street 1:390 ROBINSON AVE STE B
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3659
Practice Address - Country:US
Practice Address - Phone:330-734-6360
Practice Address - Fax:330-734-6363
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-01341231H00000X, 237600000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA4255351Medicare PIN