Provider Demographics
NPI:1124526637
Name:KACKETT, MAGGIE KERNAN (MS,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:KERNAN
Last Name:KACKETT
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:LYNN
Other - Last Name:KERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2632 ROLLING SHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-877-1199
Mailing Address - Fax:
Practice Address - Street 1:1111 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-877-1199
Practice Address - Fax:817-348-0956
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist