Provider Demographics
NPI:1386779783
Name:YOUNGSTOWN HEARING AND SPEECH CENTER
Entity type:Organization
Organization Name:YOUNGSTOWN HEARING AND SPEECH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-743-1168
Mailing Address - Street 1:299 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1599
Mailing Address - Country:US
Mailing Address - Phone:330-743-1168
Mailing Address - Fax:330-726-9182
Practice Address - Street 1:299 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1504
Practice Address - Country:US
Practice Address - Phone:330-743-1168
Practice Address - Fax:330-743-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 235Z00000X, 237600000X, 261Q00000X, 261QP2000X, 261QX0100X
OHHMEL11340332B00000X, 335E00000X
OH01856332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332S00000XSuppliersHearing Aid Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9736272Medicaid
OH9736272Medicaid
=========OtherTAX ID NUMBER
OH9736272Medicaid