Individual
OLIVIA R LUST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
516 MOUNT HOPE AVE, BANGOR, ME 04401-4215
(947) 613-1207
Mailing address
626 MAIN RD N, HAMPDEN, ME 04444-1802
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP2940
ME
235Z00000X
Speech-Language Pathologist
ST2829
ME
Other
Enumeration date
08/15/2018
Last updated
02/15/2024
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