Healthcare Provider Details

I. General information

NPI: 1992944003
Provider Name (Legal Business Name): JOANN L. MARK MS CCCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 RICHLAND MALL
ONTARIO OH
44906-3802
US

IV. Provider business mailing address

700 N COLUMBUS ST
CRESTLINE OH
44827-1455
US

V. Phone/Fax

Practice location:
  • Phone: 419-775-1091
  • Fax: 419-775-1093
Mailing address:
  • Phone: 419-462-3485
  • Fax: 419-462-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000626L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02351
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: