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NPI Code Detail

MEDICARE: MARIEL MACAULEY

MEDICARE: MARIEL MACAULEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorMC60830319WA
2390200000XStudent in an Organized Health Care Education/Training ProgramCO60855176WA
3172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1033401369
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIEL MACAULEY
Provider Business Mailing Address
First Line : 1344 W STATE RD
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-5022
Country : US
Telephone Number : 801-785-8870
Fax Number :
Provider Business Practice Location Address
First Line : 711 STATE AVE NE
Second Line :
City : OLYMPIA
State : WA
Zip : 98506-3984
Country : US
Telephone Number : 609-430-7803
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2011
Last Update Date : 11/29/2018

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Directions to “ MARIEL MACAULEY ” Practice Location

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