Provider Demographics
NPI:1720206857
Name:MACKEEN, KANDACE (SLP)
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:
Last Name:MACKEEN
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 1:945 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3498
Mailing Address - Country:US
Mailing Address - Phone:302-672-1500
Mailing Address - Fax:302-672-1714
Practice Address - Street 1:945 FOREST ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3498
Practice Address - Country:US
Practice Address - Phone:302-672-1500
Practice Address - Fax:302-672-1714
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1574235Z00000X
DE01-0001082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist