Provider Demographics
NPI:1134379852
Name:DUSCKAS, SALLIE
Entity type:Individual
Prefix:
First Name:SALLIE
Middle Name:
Last Name:DUSCKAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 ARBUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-3703
Mailing Address - Country:US
Mailing Address - Phone:814-824-6565
Mailing Address - Fax:
Practice Address - Street 1:151 ARBUCKLE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-3703
Practice Address - Country:US
Practice Address - Phone:814-824-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.3756235Z00000X
PASL001097L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist