Provider Demographics
NPI:1174846844
Name:FAUST, LEANN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:FAUST
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15316 EVANSTON CLOSE
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7160
Mailing Address - Country:US
Mailing Address - Phone:317-508-8662
Mailing Address - Fax:
Practice Address - Street 1:15316 EVANSTON CLOSE
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7160
Practice Address - Country:US
Practice Address - Phone:317-508-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003561A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist