Provider Demographics
NPI:1477681609
Name:MACNEILAGE, LINDA ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANNE
Last Name:MACNEILAGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 HARTHAN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5216
Mailing Address - Country:US
Mailing Address - Phone:512-478-7069
Mailing Address - Fax:512-479-6720
Practice Address - Street 1:606 HARTHAN ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5216
Practice Address - Country:US
Practice Address - Phone:512-478-7069
Practice Address - Fax:512-479-6720
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20929103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical