Basic Information
Provider Information
NPI: 1225215023
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUSEK
FirstName: LINDSAY
MiddleName: ELISE
NamePrefix: MRS.
NameSuffix:  
Credential: M.A.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2203 BABCOCK RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782294412
CountryCode: US
TelephoneNumber: 2106143911
FaxNumber: 2106160443
Practice Location
Address1: 2203 BABCOCK RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 78229
CountryCode: US
TelephoneNumber: 2106143911
FaxNumber: 2106160443
Other Information
ProviderEnumerationDate: 01/24/2008
LastUpdateDate: 06/19/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X24564TXY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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