Provider Demographics
NPI:1730604505
Name:MACKEY, VALENCIA BROWN (SPEECH PATHOLOGISTMA)
Entity type:Individual
Prefix:
First Name:VALENCIA
Middle Name:BROWN
Last Name:MACKEY
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGISTMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CHERRYE DELL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-8146
Mailing Address - Country:US
Mailing Address - Phone:843-563-3239
Mailing Address - Fax:
Practice Address - Street 1:106 CHERRYE DELL RD
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-8146
Practice Address - Country:US
Practice Address - Phone:843-563-3239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4977235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist