Provider Demographics
NPI:1114543329
Name:RUSHCAMP, MCKENZIE CAROL (SLP)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:CAROL
Last Name:RUSHCAMP
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:CAROL
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:14780 SW OSPREY DR STE 285
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8073
Mailing Address - Country:US
Mailing Address - Phone:503-579-7327
Mailing Address - Fax:
Practice Address - Street 1:14780 SW OSPREY DR STE 285
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-8073
Practice Address - Country:US
Practice Address - Phone:503-579-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist