Provider Demographics
NPI:1609170125
Name:MACKEY, NICOLE (MS, CCC/A)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MS, CCC/A
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MARZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/A
Mailing Address - Street 1:41 OCONNOR RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1327
Mailing Address - Country:US
Mailing Address - Phone:585-383-2216
Mailing Address - Fax:
Practice Address - Street 1:41 OCONNOR RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1327
Practice Address - Country:US
Practice Address - Phone:585-383-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002863231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist