Provider Demographics
NPI:1699299487
Name:DOMBART, AMY MICHELLE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MICHELLE
Last Name:DOMBART
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 1:2330 GLENSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1249
Mailing Address - Country:US
Mailing Address - Phone:513-375-3954
Mailing Address - Fax:
Practice Address - Street 1:1310 ADAMS RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-3327
Practice Address - Country:US
Practice Address - Phone:513-619-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2017359235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist