Healthcare Provider Details

I. General information

NPI: 1073139127
Provider Name (Legal Business Name): AUDREY FREDERICK AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 BURNET AVE STE 330
CINCINNATI OH
45219-2426
US

IV. Provider business mailing address

2825 BURNET AVE STE 330
CINCINNATI OH
45219-2426
US

V. Phone/Fax

Practice location:
  • Phone: 513-487-7715
  • Fax: 513-221-8014
Mailing address:
  • Phone: 513-487-7715
  • Fax: 513-221-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02252
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: