Provider Demographics
NPI:1124771134
Name:INGRAM, MARIA SUZANNE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SUZANNE
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 NORTHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1628
Mailing Address - Country:US
Mailing Address - Phone:513-253-6861
Mailing Address - Fax:
Practice Address - Street 1:6210 CLEVES WARSAW PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45233-4510
Practice Address - Country:US
Practice Address - Phone:513-941-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.09158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist