Individual
STACEY MACKAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3850 PARK NICOLLET BLVD, PARK NICOLLET CLINIC - SLP, ST LOUIS PARK, MN 55416
(952) 993-3025
(952) 993-1937
Mailing address
6465 WAYZATA BLVD, STE 315, ST LOUIS PARK, MN 55426-1728
(952) 993-7169
(952) 993-0300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
41342
MN
Other
Enumeration date
12/28/2005
Last updated
08/14/2018
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