Provider Demographics
NPI:1679973457
Name:VANAUSDLE, LEWIS ARDIN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:ARDIN
Last Name:VANAUSDLE
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 HELMSDALE CT
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-4000
Mailing Address - Country:US
Mailing Address - Phone:330-907-9258
Mailing Address - Fax:
Practice Address - Street 1:7 S MARSHALL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-5375
Practice Address - Country:US
Practice Address - Phone:513-420-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist