Provider Demographics
NPI:1194073189
Name:SMITH, AMY LYNNE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNNE
Last Name:SMITH
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 1:6570 GLENWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-4410
Mailing Address - Country:US
Mailing Address - Phone:513-598-9444
Mailing Address - Fax:513-598-8223
Practice Address - Street 1:6570 GLENWAY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-4410
Practice Address - Country:US
Practice Address - Phone:513-598-9444
Practice Address - Fax:513-598-8223
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2953237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist