Provider Demographics
NPI:1669716379
Name:MACKAY, ALEXANDRA ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:MACKAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-4145
Mailing Address - Country:US
Mailing Address - Phone:402-318-2869
Mailing Address - Fax:
Practice Address - Street 1:6040 S 58TH ST
Practice Address - Street 2:STE C
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-3695
Practice Address - Country:US
Practice Address - Phone:402-421-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2013-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12-040235Z00000X
NE1595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist