Provider Demographics
NPI:1003387374
Name:JACKEL, MACY NOELLE (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:NOELLE
Last Name:JACKEL
Suffix:
Gender:F
Credentials:MA, 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:PO BOX 9170
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-9170
Mailing Address - Country:US
Mailing Address - Phone:504-419-7004
Mailing Address - Fax:
Practice Address - Street 1:330 FALCONER DR STE D
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8211
Practice Address - Country:US
Practice Address - Phone:985-900-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist