Provider Demographics
NPI:1063889491
Name:DETER, MACY (MA SLP)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:DETER
Suffix:
Gender:F
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 PINE BARK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4363
Mailing Address - Country:US
Mailing Address - Phone:330-565-1446
Mailing Address - Fax:
Practice Address - Street 1:8950 EMERALD HILL DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-6101
Practice Address - Country:US
Practice Address - Phone:740-657-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12228235Z00000X
OHCOND 2016056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist