Provider Demographics
NPI:1164082806
Name:WASS, DUANE LEE (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:DUANE
Middle Name:LEE
Last Name:WASS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 W MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1704
Mailing Address - Country:US
Mailing Address - Phone:317-742-0212
Mailing Address - Fax:
Practice Address - Street 1:52 W MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1704
Practice Address - Country:US
Practice Address - Phone:317-657-8618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5363237700000X
IN17000664A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist