Provider Demographics
NPI:1013640804
Name:GROODY, MACREENA M (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MACREENA
Middle Name:M
Last Name:GROODY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9813 OAKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3153
Mailing Address - Country:US
Mailing Address - Phone:502-338-1044
Mailing Address - Fax:
Practice Address - Street 1:1877 FARNSLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4701
Practice Address - Country:US
Practice Address - Phone:502-448-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-08
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277701235Z00000X
KY285238235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty