Provider Demographics
NPI:1609170125
Name:MACKEY, NICOLE (MS, CCC/A)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MS, CCC/A
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MARZANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/A
Mailing Address - Street 1:116 LAKE HAVASU AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0811
Mailing Address - Country:US
Mailing Address - Phone:928-615-1111
Mailing Address - Fax:
Practice Address - Street 1:116 LAKE HAVASU AVE S STE 102
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0811
Practice Address - Country:US
Practice Address - Phone:928-615-1111
Practice Address - Fax:928-615-1111
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002863231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist