Provider Demographics
NPI:1265440960
Name:MACKEY, VIRGINIA (GINY) C (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA (GINY)
Middle Name:C
Last Name:MACKEY
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 1:2640 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4824
Mailing Address - Country:US
Mailing Address - Phone:717-569-4149
Mailing Address - Fax:
Practice Address - Street 1:2640 BEECHWOOD RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4824
Practice Address - Country:US
Practice Address - Phone:717-569-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL001620L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL001620LOtherSTATE LICENSE