Healthcare Provider Details

I. General information

NPI: 1205123049
Provider Name (Legal Business Name): JESSICA MARIE-FALGNER PREWITT AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11135 MONTGOMERY RD
CINCINNATI OH
45249-2338
US

IV. Provider business mailing address

376 LEATHER LEAF LN
LEBANON OH
45036-7791
US

V. Phone/Fax

Practice location:
  • Phone: 513-429-4327
  • Fax: 513-429-4346
Mailing address:
  • Phone: 937-725-1824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.01773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: