Provider Demographics
NPI:1609872183
Name:DUNST, LESLIE A (CCC-A)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:DUNST
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 FOXCHASE DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5441
Mailing Address - Country:US
Mailing Address - Phone:724-506-0518
Mailing Address - Fax:
Practice Address - Street 1:2703 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2419
Practice Address - Country:US
Practice Address - Phone:412-422-8006
Practice Address - Fax:412-422-6111
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
PAAT000912L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7401043000Medicaid
P86273Medicare UPIN
WV7401043000Medicaid