Provider Demographics
NPI:1144688722
Name:CIMAROLLI, JOANN M (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JOANN
Middle Name:M
Last Name:CIMAROLLI
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MRS
Other - First Name:JOANN
Other - Middle Name:M
Other - Last Name:CIMAROLLI-CUSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:3812 EMMA PKWY
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1210
Mailing Address - Country:US
Mailing Address - Phone:814-392-2025
Mailing Address - Fax:
Practice Address - Street 1:420 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SPENCERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45887-1210
Practice Address - Country:US
Practice Address - Phone:419-647-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.11070235Z00000X
PASL010924235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist