Provider Demographics
NPI:1427018308
Name:SZYMCZAK, CONNIE MARY (MA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARY
Last Name:SZYMCZAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9891 MONTGOMERY RD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6424
Mailing Address - Country:US
Mailing Address - Phone:513-807-0230
Mailing Address - Fax:
Practice Address - Street 1:369 W 1ST ST
Practice Address - Street 2:SUITE 406
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-3095
Practice Address - Country:US
Practice Address - Phone:937-222-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-0592231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSZ4155632Medicare PIN