Provider Demographics
NPI:1174541486
Name:REESE, CRAIG J (AUD,CCC-A;FAAA)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:J
Last Name:REESE
Suffix:
Gender:M
Credentials:AUD,CCC-A;FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3996 FULTON DR NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3051
Mailing Address - Country:US
Mailing Address - Phone:330-491-1421
Mailing Address - Fax:330-491-1425
Practice Address - Street 1:3996 FULTON DR NW
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3051
Practice Address - Country:US
Practice Address - Phone:330-491-1421
Practice Address - Fax:330-491-1425
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00952231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341903155OtherTAX ID