Provider Demographics
NPI:1306361787
Name:GERMAN, MACKENZIE CULVER
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:CULVER
Last Name:GERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1340 NUCKOLLS ROAD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008
Mailing Address - Country:US
Mailing Address - Phone:731-571-9093
Mailing Address - Fax:
Practice Address - Street 1:1340 NUCKOLLS RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1406
Practice Address - Country:US
Practice Address - Phone:731-571-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5930235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist