=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144512963
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENN C HOEHNE CCC-SLP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 05/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8580 TOWNSHIP ROAD 237
-----------------------------------------------------
City | FINDLAY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45840-8507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 567-525-4460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 BLACKTHORN DR
-----------------------------------------------------
City | OTTAWA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45875-1004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-523-3315
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 5613
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------