Provider Demographics
NPI:1164194585
Name:BAIR, MACKENZIE (SLP)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:BAIR
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W IRISH LN
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336-1020
Mailing Address - Country:US
Mailing Address - Phone:660-687-0187
Mailing Address - Fax:660-687-0221
Practice Address - Street 1:1800 W IRISH LN
Practice Address - Street 2:
Practice Address - City:KNOB NOSTER
Practice Address - State:MO
Practice Address - Zip Code:65336-1020
Practice Address - Country:US
Practice Address - Phone:660-687-0187
Practice Address - Fax:660-687-0221
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021032072235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist