Provider Demographics
NPI:1659504397
Name:DILTS, LYNETTE VITUCCI (MS/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:VITUCCI
Last Name:DILTS
Suffix:
Gender:F
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 1:6550 W 250 S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8952
Mailing Address - Country:US
Mailing Address - Phone:812-342-7358
Mailing Address - Fax:
Practice Address - Street 1:4895 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2569
Practice Address - Country:US
Practice Address - Phone:812-342-3098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004704A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist