Provider Demographics
NPI:1982816336
Name:PLUTA, LYNN MARIE (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MARIE
Last Name:PLUTA
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3219 SAND WOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-6147
Mailing Address - Country:US
Mailing Address - Phone:574-271-7283
Mailing Address - Fax:
Practice Address - Street 1:32772 DEER WATCH CT
Practice Address - Street 2:
Practice Address - City:NEW CARLISLE
Practice Address - State:IN
Practice Address - Zip Code:46552-9690
Practice Address - Country:US
Practice Address - Phone:574-654-8540
Practice Address - Fax:574-654-9183
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003283A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist