Provider Demographics
NPI:1891025847
Name:MACKINNON, ANGELA SUZANNE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SUZANNE
Last Name:MACKINNON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:NH
Mailing Address - Zip Code:03574
Mailing Address - Country:US
Mailing Address - Phone:603-616-9117
Mailing Address - Fax:
Practice Address - Street 1:1161 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:NH
Practice Address - Zip Code:03574
Practice Address - Country:US
Practice Address - Phone:603-616-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist