Provider Demographics
NPI:1396032728
Name:MACKNAIR, ANNE ELIZABETH (SPEECH-LANGUAGE PATH)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:ELIZABETH
Last Name:MACKNAIR
Suffix:
Gender:F
Credentials:SPEECH-LANGUAGE PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 DOELNER CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9752
Mailing Address - Country:US
Mailing Address - Phone:518-727-1196
Mailing Address - Fax:
Practice Address - Street 1:101 LORALEE DRIVE
Practice Address - Street 2:SOUTH COLONIE CENTRAL SCHOOL DISTRICT
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-869-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004392-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist