Provider Demographics
NPI:1558678037
Name:PANTAZ, DARCEE LYNN
Entity Type:Individual
Prefix:
First Name:DARCEE
Middle Name:LYNN
Last Name:PANTAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ALGONQUIN LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-9512
Mailing Address - Country:US
Mailing Address - Phone:207-729-9908
Mailing Address - Fax:
Practice Address - Street 1:587 ELMWOOD RD
Practice Address - Street 2:
Practice Address - City:POWNAL
Practice Address - State:ME
Practice Address - Zip Code:04069-6139
Practice Address - Country:US
Practice Address - Phone:207-688-4832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist