Provider Demographics
NPI:1801924543
Name:LUEBBE-GEARHART, MARY LOU (AUD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:LOU
Last Name:LUEBBE-GEARHART
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 1:5074 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1526
Mailing Address - Country:US
Mailing Address - Phone:614-431-1010
Mailing Address - Fax:614-847-0015
Practice Address - Street 1:5074 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1526
Practice Address - Country:US
Practice Address - Phone:614-431-1010
Practice Address - Fax:614-847-0015
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00304231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0048022Medicaid
OH0592185Medicaid
OH0048022Medicaid
OH0549962Medicare PIN