Provider Demographics
NPI:1447724596
Name:CONSTANTINE, SUSAN VAZZANA (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:VAZZANA
Last Name:CONSTANTINE
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 MUNFORD DR
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2219
Mailing Address - Country:US
Mailing Address - Phone:443-417-5018
Mailing Address - Fax:
Practice Address - Street 1:2422 MUNFORD DR
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2219
Practice Address - Country:US
Practice Address - Phone:443-417-5018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02163235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist