Provider Demographics
NPI:1083343214
Name:MACKENNA, MAEVE CATHERINE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:MAEVE
Middle Name:CATHERINE
Last Name:MACKENNA
Suffix:
Gender:F
Credentials:MS, CF-SLP
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Other - Last Name:
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Mailing Address - Street 1:6 CARYL PL
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2919
Mailing Address - Country:US
Mailing Address - Phone:631-708-9909
Mailing Address - Fax:
Practice Address - Street 1:1 CRAIG B GARIEPY AVE
Practice Address - Street 2:
Practice Address - City:ISLIP TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11752-2820
Practice Address - Country:US
Practice Address - Phone:631-650-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist