Healthcare Provider Details

I. General information

NPI: 1740367226
Provider Name (Legal Business Name): MARY BETH BOND BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N 4TH ST
IRONTON OH
45638-1499
US

IV. Provider business mailing address

119 N 4TH ST
IRONTON OH
45638-1499
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-1942
  • Fax: 740-532-1943
Mailing address:
  • Phone: 740-532-1942
  • Fax: 740-532-1943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number01892
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: