Provider Demographics
NPI:1376223479
Name:SCHABLE, MCKENZIE J
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:J
Last Name:SCHABLE
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 1:12356 ZEALAND CIR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-1952
Mailing Address - Country:US
Mailing Address - Phone:612-267-8504
Mailing Address - Fax:
Practice Address - Street 1:6409 CITY WEST PKWY STE 206
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7846
Practice Address - Country:US
Practice Address - Phone:952-500-8871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist