Healthcare Provider Details

I. General information

NPI: 1194848226
Provider Name (Legal Business Name): DAWN B. ROMANCZAK MACCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

053 MCKINLY LAB
NEWARK DE
19716
US

IV. Provider business mailing address

193 WATSON MILL RD
LANDENBERG PA
19350-9344
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-8893
  • Fax:
Mailing address:
  • Phone: 610-274-1648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO10000953
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: