Healthcare Provider Details

I. General information

NPI: 1639080955
Provider Name (Legal Business Name): MACKINLEY TODD MCNEIL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 VIOLA ST
MANDEVILLE LA
70448-8609
US

IV. Provider business mailing address

42171 MILLBROOK WAY
PONCHATOULA LA
70454-4242
US

V. Phone/Fax

Practice location:
  • Phone: 985-674-3011
  • Fax:
Mailing address:
  • Phone: 251-423-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10003
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: