Provider Demographics
NPI:1235379728
Name:MACKEY, COURTNEY (MSP, CCC-CFY)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MSP, CCC-CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 EBENEZER RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4103
Mailing Address - Country:US
Mailing Address - Phone:803-329-1520
Mailing Address - Fax:803-366-5027
Practice Address - Street 1:1721 EBENEZER RD
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-4103
Practice Address - Country:US
Practice Address - Phone:803-329-1520
Practice Address - Fax:803-366-5027
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4319OtherSC LICENSE