Individual
VINCENT LUSTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., CCC-A
Contact information
Practice address
2205 WASHINGTON ST E, CHARLESTON, WV 25311-2218
(304) 345-8522
(304) 344-5305
Mailing address
5006 RENARD ST, SISSONVILLE, WV 25320-9623
(304) 988-1760
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A0063
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0160699000
—
WV
01
—
1022588
WORKER'S COMP
WV
Enumeration date
04/17/2007
Last updated
07/09/2007
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