Provider Demographics
NPI:1033376694
Name:DYKEMAN, SUSAN WILLCOX (MAC LAC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WILLCOX
Last Name:DYKEMAN
Suffix:
Gender:F
Credentials:MAC LAC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:DYKEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAC LAC
Mailing Address - Street 1:6508 CARDIGAN ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-717-8204
Mailing Address - Fax:301-767-3937
Practice Address - Street 1:6801 KENILWORTH AVE STE 300
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1331
Practice Address - Country:US
Practice Address - Phone:301-717-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01583171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist