Provider Demographics
NPI:1568891869
Name:MACNEIL, KATHLEEN (SLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MACNEIL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-4551
Mailing Address - Country:US
Mailing Address - Phone:512-750-7170
Mailing Address - Fax:512-352-3270
Practice Address - Street 1:1708 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-4551
Practice Address - Country:US
Practice Address - Phone:512-750-7170
Practice Address - Fax:512-352-3270
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
CASP6204235Z00000X
TX100289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist