MEDICARE: MS. STEPHANIE MACKEY M.S.

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
1	231H00000X	Audiologist	AU2471	CA

General Provider Information

NPI Number	:	1245364967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE MACKEY M.S.

Provider Business Mailing Address
First Line	:	1612 STRANDWAY COURT
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-1731
Country	:	US
Telephone Number	:	805-449-1004
Fax Number	:

Provider Business Practice Location Address
First Line	:	3825 E THOUSAND OAKS BLVD STE O
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-6637
Country	:	US
Telephone Number	:	805-496-1674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	09/09/2022

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