Provider Demographics
NPI:1417438029
Name:GUNTHER, MCKENZIE LYNN (MS)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LYNN
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2422
Mailing Address - Country:US
Mailing Address - Phone:309-642-1789
Mailing Address - Fax:
Practice Address - Street 1:110 S BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2422
Practice Address - Country:US
Practice Address - Phone:309-642-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist