Provider Demographics
NPI:1780988824
Name:DUST, ANN MARIE DELIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:DELIA
Last Name:DUST
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ANN MARIE
Other - Middle Name:DELIA
Other - Last Name:LUTHOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9733 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9420
Mailing Address - Country:US
Mailing Address - Phone:317-439-3225
Mailing Address - Fax:
Practice Address - Street 1:344 S RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-7142
Practice Address - Country:US
Practice Address - Phone:317-602-3847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004249A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist