Provider Demographics
NPI:1518158542
Name:LUE PANN, DAMIAN MICHAEL
Entity Type:Individual
Prefix:MR
First Name:DAMIAN
Middle Name:MICHAEL
Last Name:LUE PANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13513 TOPAZ LAKE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7467
Mailing Address - Country:US
Mailing Address - Phone:407-281-1740
Mailing Address - Fax:
Practice Address - Street 1:13513 TOPAZ LAKE CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7467
Practice Address - Country:US
Practice Address - Phone:407-281-1740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist