Healthcare Provider Details

I. General information

NPI: 1164043659
Provider Name (Legal Business Name): ASHLEY VERBA AUDIOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY KUMINKOSKI AUDIOLOGIST

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 11/15/2024
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S. BURNETT RD.
SPRINGFIELD OH
45505
US

IV. Provider business mailing address

435 S. BURNETT RD.
SPRINGFIELD OH
45505
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-8796
  • Fax: 937-325-6698
Mailing address:
  • Phone: 937-325-8796
  • Fax: 937-325-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number200642800
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02412
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: