Provider Demographics
NPI:1730556960
Name:DESELL-LUND, PAULETTE MARIE (MA, CCC-SP)
Entity type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:MARIE
Last Name:DESELL-LUND
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 PLOT RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON
Mailing Address - State:VT
Mailing Address - Zip Code:05656-5924
Mailing Address - Country:US
Mailing Address - Phone:802-644-2620
Mailing Address - Fax:
Practice Address - Street 1:5012 PLOT RD
Practice Address - Street 2:
Practice Address - City:JOHNSON
Practice Address - State:VT
Practice Address - Zip Code:05656-5924
Practice Address - Country:US
Practice Address - Phone:802-644-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0114359235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist