Provider Demographics
NPI:1457840001
Name:MENTE, MAKENZIE (SLP)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:MENTE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:IA
Mailing Address - Zip Code:52777-9700
Mailing Address - Country:US
Mailing Address - Phone:563-249-8076
Mailing Address - Fax:
Practice Address - Street 1:316 E LINCOLNWAY ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:IA
Practice Address - Zip Code:52777-9717
Practice Address - Country:US
Practice Address - Phone:563-374-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist