Provider Demographics
NPI:1609617042
Name:DEWITT, MACY (CF-SLP)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials: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 441
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:KS
Mailing Address - Zip Code:67546-0441
Mailing Address - Country:US
Mailing Address - Phone:620-242-3985
Mailing Address - Fax:
Practice Address - Street 1:1000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2326
Practice Address - Country:US
Practice Address - Phone:620-241-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist