Provider Demographics
NPI:1942862727
Name:CLANCY, NANCY (SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BOUCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2205
Mailing Address - Country:US
Mailing Address - Phone:508-954-7011
Mailing Address - Fax:
Practice Address - Street 1:SOUTH BAY COMMUNITY SERVICES
Practice Address - Street 2:142 WARREN ST
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-452-1739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1696235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist