Susan Vazzana Constantine, MS CCC/SLP
Individual provider Active NPI Speech-Language Pathologist · Fallston, MD
NPI 1447724596 · NPPES record last updated Jan 11, 2019
Key facts
- NPI
- 1447724596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 02163 (MD)
- Practice address
- 2422 Munford Dr
Fallston, MD 21047-2219 - Phone
- (443) 417-5018
- NPI assigned
- Jan 11, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02163 | MD | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 02163 | MD | Yes |
Addresses
Primary practice location
2422 Munford Dr
Fallston, MD 21047-2219
Mailing address
2422 Munford Dr
Fallston, MD 21047-2219
Phone (443) 417-5018
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All providers in Fallston, MD · Speech-Language Pathologist in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.