Individual
KIMBERLY ANTUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
150 ERIE CT, AMHERST, OH 44001-1724
(440) 984-2416
(440) 984-2422
Mailing address
39157 CAMELOT WAY, AVON, OH 44011-3628
(419) 297-9319
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7411
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
366504
MEDICARE
OH
05
—
7255198
—
OH
Enumeration date
04/29/2009
Last updated
04/29/2009
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