Provider Demographics
NPI:1255651626
Name:DUSTIN, JANET L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:DUSTIN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:L
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:298 N 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8874
Mailing Address - Country:US
Mailing Address - Phone:970-301-0787
Mailing Address - Fax:
Practice Address - Street 1:298 N 60TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8874
Practice Address - Country:US
Practice Address - Phone:970-301-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist