Healthcare Provider Details

I. General information

NPI: 1629050182
Provider Name (Legal Business Name): THERESA KINNEY AUD, CCC/A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 05/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5689 GRANTHAM LN
DUBLIN OH
43016-3260
US

IV. Provider business mailing address

5689 GRANTHAM LN
DUBLIN OH
43016-3260
US

V. Phone/Fax

Practice location:
  • Phone: 440-241-8853
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01105
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number01105
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: