Provider Demographics
NPI:1679321681
Name:ORTIZ VILLABONA, CLARISSA (AUD)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:
Last Name:ORTIZ VILLABONA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-366-3257
Mailing Address - Fax:
Practice Address - Street 1:6700 UNIVERSITY BLVD FL 2
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3508
Practice Address - Country:US
Practice Address - Phone:614-366-3257
Practice Address - Fax:614-293-1688
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02508231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist