Provider Demographics
NPI:1730920885
Name:CUSATIS, LUANNE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LUANNE
Middle Name:
Last Name:CUSATIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ROCKLEDGE RD
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-5835
Mailing Address - Country:US
Mailing Address - Phone:570-417-2164
Mailing Address - Fax:
Practice Address - Street 1:918 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:PA
Practice Address - Zip Code:18626-7007
Practice Address - Country:US
Practice Address - Phone:570-946-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008883235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist