Provider Demographics
NPI:1770215691
Name:MAYNARD, MACY (CF-SLP)
Entity Type:Individual
Prefix:MS
First Name:MACY
Middle Name:
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2682
Mailing Address - Country:US
Mailing Address - Phone:865-621-4249
Mailing Address - Fax:865-381-1371
Practice Address - Street 1:1240 OLD WEISGARBER RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2682
Practice Address - Country:US
Practice Address - Phone:865-621-4249
Practice Address - Fax:865-381-1371
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7965235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist