Healthcare Provider Details

I. General information

NPI: 1841361680
Provider Name (Legal Business Name): RHONDA A LAVIN MSCCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RHONDA A. MAX

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9464 US HIGHWAY 36
SAINT PARIS OH
43072-9367
US

IV. Provider business mailing address

2200 SOUTHLEA DR
DAYTON OH
45459-3641
US

V. Phone/Fax

Practice location:
  • Phone: 937-663-4449
  • Fax:
Mailing address:
  • Phone: 937-266-7054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 5560
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: