MEDICARE: MRS. JANEY MARIE MACEY M.C.D, CCC-SLP

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	103K00000X	Behavior Analyst	L-143	LA
2	235Z00000X	Speech-Language Pathologist	5027	LA

General Provider Information

NPI Number	:	1275695736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANEY MARIE MACEY M.C.D, CCC-SLP

Provider Business Mailing Address
First Line	:	2285 BENTON RD
Second Line	:	SUITE C-200
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7933
Country	:	US
Telephone Number	:	318-741-5909
Fax Number	:	318-741-5911

Provider Business Practice Location Address
First Line	:	2285 BENTON RD
Second Line	:	SUITE C-200
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-7933
Country	:	US
Telephone Number	:	318-741-5909
Fax Number	:	318-741-5911

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	01/24/2020

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