Provider Demographics
NPI:1659001675
Name:MACKIE, HANNAH LOUISE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LOUISE
Last Name:MACKIE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 DONOVAN CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-4769
Mailing Address - Country:US
Mailing Address - Phone:786-766-4813
Mailing Address - Fax:
Practice Address - Street 1:152 DONOVAN CT
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-4769
Practice Address - Country:US
Practice Address - Phone:785-760-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist