Provider Demographics
NPI:1467158675
Name:ARNOLD, MACKENZIE LOWERY
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LOWERY
Last Name:ARNOLD
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 1:105 HOLLENDEN LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9789
Mailing Address - Country:US
Mailing Address - Phone:601-624-6789
Mailing Address - Fax:
Practice Address - Street 1:105 HOLLENDEN LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9789
Practice Address - Country:US
Practice Address - Phone:601-624-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist