Provider Demographics
NPI:1780839795
Name:MACKEN, KATRINA MARIE
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MARIE
Last Name:MACKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5022
Mailing Address - Country:US
Mailing Address - Phone:516-390-9881
Mailing Address - Fax:
Practice Address - Street 1:1630 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-5022
Practice Address - Country:US
Practice Address - Phone:516-390-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017546-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist