Provider Demographics
NPI:1043993074
Name:LUETHMERS, ANN VANDERBILT (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:VANDERBILT
Last Name:LUETHMERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23602 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTA
Mailing Address - State:MN
Mailing Address - Zip Code:56301-9225
Mailing Address - Country:US
Mailing Address - Phone:952-212-0468
Mailing Address - Fax:
Practice Address - Street 1:23602 69TH AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTA
Practice Address - State:MN
Practice Address - Zip Code:56301-9225
Practice Address - Country:US
Practice Address - Phone:952-212-0468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN528502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist