Healthcare Provider Details

I. General information

NPI: 1659453033
Provider Name (Legal Business Name): MARY BETH SPITZNAGEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST SUITE G2
AKRON OH
44304-1429
US

IV. Provider business mailing address

PO BOX 1462
STOW OH
44224-0462
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3747
  • Fax: 330-375-4939
Mailing address:
  • Phone: 330-379-8148
  • Fax: 330-379-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6123
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: