Provider Demographics
NPI:1962639872
Name:DWINAL, CONSTANCE (SLP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:DWINAL
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 1:635 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3415
Mailing Address - Country:US
Mailing Address - Phone:603-524-1741
Mailing Address - Fax:603-524-0262
Practice Address - Street 1:635 MAIN ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3415
Practice Address - Country:US
Practice Address - Phone:603-524-1741
Practice Address - Fax:603-524-0262
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0417235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0417OtherSLP LICENSE