Provider Demographics
NPI:1235825480
Name:VAN SAVAGE, MACEY TAYLOR
Entity Type:Individual
Prefix:
First Name:MACEY
Middle Name:TAYLOR
Last Name:VAN SAVAGE
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 1:7125 WINTER POND WAY
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5486
Mailing Address - Country:US
Mailing Address - Phone:919-348-9174
Mailing Address - Fax:
Practice Address - Street 1:7125 WINTER POND WAY
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5486
Practice Address - Country:US
Practice Address - Phone:919-348-9174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist