Healthcare Provider Details

I. General information

NPI: 1912465006
Provider Name (Legal Business Name): IVEY MARIA TZETZIS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IVEY MARIA BROWN

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6642 BRANCH HILL-GUINEA PIKE
LOVELAND OH
45140
US

IV. Provider business mailing address

6642 BRANCH HILL-GUINEA PIKE
LOVELAND OH
45140
US

V. Phone/Fax

Practice location:
  • Phone: 513-791-1458
  • Fax:
Mailing address:
  • Phone: 513-791-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.13307
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: