Provider Demographics
NPI:1760247589
Name:MACKAY, COLIN IAN (HAD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:IAN
Last Name:MACKAY
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 DELL RANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-4917
Mailing Address - Country:US
Mailing Address - Phone:307-274-9843
Mailing Address - Fax:307-772-4463
Practice Address - Street 1:1948 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4917
Practice Address - Country:US
Practice Address - Phone:307-274-9843
Practice Address - Fax:307-772-4463
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO273237700000X
WY239237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist