Provider Demographics
NPI:1689866816
Name:DANCEWICZ, SUSAN (MSCCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DANCEWICZ
Suffix:
Gender:F
Credentials:MSCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 NEWCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1936
Mailing Address - Country:US
Mailing Address - Phone:978-531-6108
Mailing Address - Fax:
Practice Address - Street 1:14 NEWCASTLE RD
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1936
Practice Address - Country:US
Practice Address - Phone:978-531-6108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-12
Last Update Date:2007-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1152-SL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist