Provider Demographics
NPI:1942328729
Name:MACISAAC, JOAN A (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:A
Last Name:MACISAAC
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 1:35800 PARK HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND HILL
Mailing Address - State:VA
Mailing Address - Zip Code:20141-4408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20535 EARHART PL
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-3581
Practice Address - Country:US
Practice Address - Phone:703-404-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002458235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist