Provider Demographics
NPI:1639377377
Name:MAKIE, JEANIE (MS,CCC,SLP)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:
Last Name:MAKIE
Suffix:
Gender:F
Credentials:MS,CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 FROST AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1315
Mailing Address - Country:US
Mailing Address - Phone:781-929-6849
Mailing Address - Fax:
Practice Address - Street 1:78 FROST AVE
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-1315
Practice Address - Country:US
Practice Address - Phone:781-929-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2414235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist