Provider Demographics
NPI:1356008973
Name:SPEIGHT, MCKENZIE LYMAN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LYMAN
Last Name:SPEIGHT
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17026 TRAIL OF THE WOODS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-1046
Mailing Address - Country:US
Mailing Address - Phone:512-797-4670
Mailing Address - Fax:
Practice Address - Street 1:2800 S I-35 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704
Practice Address - Country:US
Practice Address - Phone:956-377-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14361433235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty