Provider Demographics
NPI:1154337673
Name:SILLS, AUDREY E (SLP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:E
Last Name:SILLS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-9737
Mailing Address - Country:US
Mailing Address - Phone:330-332-2473
Mailing Address - Fax:
Practice Address - Street 1:718 E 3RD ST
Practice Address - Street 2:SUITE A
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2915
Practice Address - Country:US
Practice Address - Phone:330-332-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist