Provider Demographics
NPI:1548415961
Name:MACKAY, LORI ANN (MA, CCC-SLP,TSHH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:MACKAY
Suffix:
Gender:F
Credentials:MA, CCC-SLP,TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 LEFURGY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706
Mailing Address - Country:US
Mailing Address - Phone:914-478-6270
Mailing Address - Fax:
Practice Address - Street 1:120 LEFURGY AVENUE
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706
Practice Address - Country:US
Practice Address - Phone:914-478-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012244-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist