Provider Demographics
NPI:1871877258
Name:PUCKETT, DUSTI D (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:DUSTI
Middle Name:D
Last Name:PUCKETT
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 1:13700 CADORNA STRADA
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-5141
Mailing Address - Country:US
Mailing Address - Phone:405-229-7823
Mailing Address - Fax:405-387-5845
Practice Address - Street 1:13700 CADORNA STRADA
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-5141
Practice Address - Country:US
Practice Address - Phone:405-229-7823
Practice Address - Fax:405-387-5845
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist