Provider Demographics
NPI:1326485640
Name:MACIAS, VERONICA KAY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:VERONICA
Middle Name:KAY
Last Name:MACIAS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CIRCLE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-8111
Mailing Address - Country:US
Mailing Address - Phone:817-566-1100
Mailing Address - Fax:817-531-2459
Practice Address - Street 1:1100 CIRCLE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-8111
Practice Address - Country:US
Practice Address - Phone:817-566-1100
Practice Address - Fax:817-531-2459
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist