Provider Demographics
NPI:1407438880
Name:FREY, DUSTIN JAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:JAY
Last Name:FREY
Suffix:
Gender:M
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 1:3225 HOAGLIN RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-8755
Mailing Address - Country:US
Mailing Address - Phone:419-203-9924
Mailing Address - Fax:
Practice Address - Street 1:3225 HOAGLIN RD
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-8755
Practice Address - Country:US
Practice Address - Phone:419-203-9924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10828235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty