Healthcare Provider Details

I. General information

NPI: 1871896324
Provider Name (Legal Business Name): DAWN R SEMANCIK MA, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12691 W SMOKEY DR STE 131
SURPRISE AZ
85378-3800
US

IV. Provider business mailing address

4400 N 32ND ST STE 220
PHOENIX AZ
85018-3965
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-1737
  • Fax: 623-583-0607
Mailing address:
  • Phone: 623-512-4100
  • Fax: 623-512-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberDA10694
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: