Healthcare Provider Details

I. General information

NPI: 1578883195
Provider Name (Legal Business Name): CLAIRE ANN MACKEY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON AVE PO BX 245
COXSACKIE NY
12051-1206
US

IV. Provider business mailing address

1 WASHINGTON AVE PO BX 245
COXSACKIE NY
12051-1206
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-8542
  • Fax:
Mailing address:
  • Phone: 518-731-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number010437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: