Provider Demographics
NPI:1013183367
Name:MACCORMACK, STEPHEN (MS-CCC/SLP, EDS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:MACCORMACK
Suffix:
Gender:M
Credentials:MS-CCC/SLP, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:COHASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02025-1905
Mailing Address - Country:US
Mailing Address - Phone:781-383-6901
Mailing Address - Fax:
Practice Address - Street 1:86 MILL ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6438
Practice Address - Country:US
Practice Address - Phone:978-469-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3121235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist