Provider Demographics
NPI:1871265967
Name:MACKAY, SHEENA ROSEANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:ROSEANN
Last Name:MACKAY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204A ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2300
Mailing Address - Country:US
Mailing Address - Phone:619-431-5049
Mailing Address - Fax:
Practice Address - Street 1:4204A ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2300
Practice Address - Country:US
Practice Address - Phone:619-431-5049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist