Provider Demographics
NPI:1629303102
Name:JANECZEK, SUSAN JENNIFER (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:JENNIFER
Last Name:JANECZEK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 MARSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-1416
Mailing Address - Country:US
Mailing Address - Phone:978-452-0077
Mailing Address - Fax:
Practice Address - Street 1:2 WATER ST
Practice Address - Street 2:C/O WOMEN'S HEALTHCARE
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6229
Practice Address - Country:US
Practice Address - Phone:978-556-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2052225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist