Provider Demographics
NPI:1083235337
Name:MACKOWIAK, ANGELA MARY
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARY
Last Name:MACKOWIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1757
Mailing Address - Country:US
Mailing Address - Phone:716-785-4334
Mailing Address - Fax:
Practice Address - Street 1:3023 NY-430
Practice Address - Street 2:
Practice Address - City:GREENHURST
Practice Address - State:NY
Practice Address - Zip Code:14742
Practice Address - Country:US
Practice Address - Phone:716-483-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist