Provider Demographics
NPI:1447005772
Name:MACKANICK, MARIA (MS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MACKANICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:NANTY GLO
Mailing Address - State:PA
Mailing Address - Zip Code:15943-1335
Mailing Address - Country:US
Mailing Address - Phone:814-421-9872
Mailing Address - Fax:
Practice Address - Street 1:120 IRMC DR
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3674
Practice Address - Country:US
Practice Address - Phone:724-357-7068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist