Provider Demographics
NPI:1508426578
Name:VESELIC, MCKENZIE A (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:A
Last Name:VESELIC
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 1:4432 NE 83RD TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-7612
Mailing Address - Country:US
Mailing Address - Phone:816-799-7251
Mailing Address - Fax:
Practice Address - Street 1:1806 SWIFT AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3600
Practice Address - Country:US
Practice Address - Phone:302-681-6804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO235Z00000X
MO2017025378235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist