Provider Demographics
NPI:1487606778
Name:METZGER, MATTHEW A (AUD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:METZGER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 42356
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-0356
Mailing Address - Country:US
Mailing Address - Phone:513-448-7960
Mailing Address - Fax:
Practice Address - Street 1:10999 REED HARTMAN HWY STE 232
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-8311
Practice Address - Country:US
Practice Address - Phone:513-448-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02092231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0412945Medicaid
CO98451286Medicaid