Provider Demographics
NPI:1215193594
Name:MACICEK, KATHRYN LISTI (MS, CCC, SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LISTI
Last Name:MACICEK
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 1:317 BLUEBONNET DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5412
Mailing Address - Country:US
Mailing Address - Phone:337-288-0808
Mailing Address - Fax:
Practice Address - Street 1:317 BLUEBONNET DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5412
Practice Address - Country:US
Practice Address - Phone:337-288-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5858235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist