Healthcare Provider Details

I. General information

NPI: 1275695736
Provider Name (Legal Business Name): JANEY MARIE MACEY M.C.D, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 BENTON RD SUITE C-200
BOSSIER CITY LA
71111-7933
US

IV. Provider business mailing address

2285 BENTON RD SUITE C-200
BOSSIER CITY LA
71111-7933
US

V. Phone/Fax

Practice location:
  • Phone: 318-741-5909
  • Fax: 318-741-5911
Mailing address:
  • Phone: 318-741-5909
  • Fax: 318-741-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5027
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-143
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: