Provider Demographics
NPI:1164640199
Name:MCKENZIE, MARGARET WADDLE
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:WADDLE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 E GENTLE OAKS LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-6119
Mailing Address - Country:US
Mailing Address - Phone:479-443-5642
Mailing Address - Fax:
Practice Address - Street 1:437 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72740
Practice Address - Country:US
Practice Address - Phone:479-738-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist