MEDICARE: MISS VERONICA KAY MACIAS M.S., 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	235Z00000X	Speech-Language Pathologist	105935	TX

General Provider Information

NPI Number	:	1326485640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VERONICA KAY MACIAS M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1100 CIRCLE DR
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76119-8111
Country	:	US
Telephone Number	:	817-566-1100
Fax Number	:	817-531-2459

Provider Business Practice Location Address
First Line	:	1100 CIRCLE DR
Second Line	:	SUITE 101
City	:	FORT WORTH
State	:	TX
Zip	:	76119-8111
Country	:	US
Telephone Number	:	817-566-1100
Fax Number	:	817-531-2459

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

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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Directions to “ MISS VERONICA KAY MACIAS M.S., CCC-SLP” Practice Location

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