Provider Demographics
NPI:1104095595
Name:DANNENBERG, SUSAN MARTEL (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARTEL
Last Name:DANNENBERG
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LYNNE
Other - Last Name:MARTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:143 MERRIMON AVENUE SUITE A
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1815
Mailing Address - Country:US
Mailing Address - Phone:828-254-8889
Mailing Address - Fax:828-254-8887
Practice Address - Street 1:143 MERRIMON AVENUE SUITE A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1815
Practice Address - Country:US
Practice Address - Phone:828-254-8889
Practice Address - Fax:828-254-8887
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist