Provider Demographics
NPI:1366138422
Name:SIMPSON, MAXIMILIAN (HIS)
Entity type:Individual
Prefix:MR
First Name:MAXIMILIAN
Middle Name:
Last Name:SIMPSON
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2104
Mailing Address - Country:US
Mailing Address - Phone:304-521-4365
Mailing Address - Fax:513-332-9072
Practice Address - Street 1:765 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-2130
Practice Address - Country:US
Practice Address - Phone:740-286-3656
Practice Address - Fax:513-332-9072
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237700000X
KY292456237700000X
OHIL.03521237700000X
WV1110237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist