Active NPI
Blake Vonderhaar
- Speech-Language Pathologist
- Liberty TWP, OH
National Provider Identifier
1033853692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SP.14887
- Practice address
- 6475 Lesourdsville West Chester Rd
Liberty TWP, OH 45011-8455 - Phone
- (513) 644-1150
- NPI assigned
- Apr 20, 2022
- Last updated
- Aug 14, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SP.14887 | OH | Primary |
| Speech-Language Pathologist | 235Z00000X | COND.20211810-SP | OH |
Addresses
Primary practice location
6475 Lesourdsville West Chester Rd
Liberty TWP, OH 45011-8455
Mailing address
5875 E Senour Dr
West Chester, OH 45069-1396
Phone (513) 907-4290
Other practice location 1
5414 Hankins Rd
Middletown, OH 45044-9782
Phone (513) 863-7775
Other practice location 2
501 W Lexington Rd
Eaton, OH 45320-9274
Phone (937) 456-9535
Other names 1
- Blake Fishman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COND.20211810-SP | OH | MD | Speech-Language Pathologist |
| SP.14887 | OH | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691971200000",
"number": "1033853692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5875 E SENOUR DR",
"city": "WEST CHESTER",
"state": "OH",
"postal_code": "450691396",
"telephone_number": "513-907-4290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6475 LESOURDSVILLE WEST CHESTER RD",
"city": "LIBERTY TWP",
"state": "OH",
"postal_code": "450118455",
"telephone_number": "513-644-1150"
}
],
"practiceLocations": [
{
"address_1": "5414 Hankins Rd",
"address_purpose": "LOCATION",
"city": "Middletown",
"state": "OH",
"postal_code": "450449782",
"country_code": "US",
"telephone_number": "513-863-7775",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "501 W Lexington Rd",
"address_purpose": "LOCATION",
"city": "Eaton",
"state": "OH",
"postal_code": "453209274",
"country_code": "US",
"telephone_number": "937-456-9535",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VONDERHAAR",
"first_name": "BLAKE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-20",
"last_updated": "2023-08-14",
"certification_date": "2023-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "SP.14887",
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OH",
"license": "COND.20211810-SP",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BLAKE",
"last_name": "FISHMAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Liberty TWP, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.