Provider Demographics
NPI:1821079419
Name:WUST, SILVIA ALEJANDRA (AUD , CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:SILVIA
Middle Name:ALEJANDRA
Last Name:WUST
Suffix:
Gender:F
Credentials:AUD , CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 PORTSMOUTH LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5814
Mailing Address - Country:US
Mailing Address - Phone:678-341-9958
Mailing Address - Fax:678-284-2770
Practice Address - Street 1:11555 MEDLOCK BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3200
Practice Address - Country:US
Practice Address - Phone:877-828-1688
Practice Address - Fax:678-284-2770
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003894237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist