Provider Demographics
NPI:1164174074
Name:FLACK, MACEY (SLP)
Entity Type:Individual
Prefix:
First Name:MACEY
Middle Name:
Last Name:FLACK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MACEY
Other - Middle Name:
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1025 HERKIMER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-6743
Mailing Address - Country:US
Mailing Address - Phone:713-659-2803
Mailing Address - Fax:
Practice Address - Street 1:3000 WESLAYAN ST STE 105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5701
Practice Address - Country:US
Practice Address - Phone:713-218-9947
Practice Address - Fax:713-218-8988
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist