Healthcare Provider Details

I. General information

NPI: 1043125669
Provider Name (Legal Business Name): DOMINIC PELLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 BACH BUXTON RD
BATAVIA OH
45103-2886
US

IV. Provider business mailing address

4350 AICHOLTZ RD
CINCINNATI OH
45245-3500
US

V. Phone/Fax

Practice location:
  • Phone: 513-947-7600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01477
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: