Provider Demographics
NPI:1215027339
Name:DEVRIES, LUANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LUANNE
Middle Name:
Last Name:DEVRIES
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 1:9878 WOODLANDS DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9313
Mailing Address - Country:US
Mailing Address - Phone:317-578-7882
Mailing Address - Fax:317-576-9380
Practice Address - Street 1:9878 WOODLANDS DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9313
Practice Address - Country:US
Practice Address - Phone:317-578-7882
Practice Address - Fax:317-576-9380
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002648235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist