Provider Demographics
NPI:1518549773
Name:COULTER, MACKENZIE ALYSE (BAA)
Entity Type:Individual
Prefix:MISS
First Name:MACKENZIE
Middle Name:ALYSE
Last Name:COULTER
Suffix:
Gender:F
Credentials:BAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2172 N BLOCK RD
Mailing Address - Street 2:
Mailing Address - City:REESE
Mailing Address - State:MI
Mailing Address - Zip Code:48757-9347
Mailing Address - Country:US
Mailing Address - Phone:989-415-8362
Mailing Address - Fax:
Practice Address - Street 1:5447 HAMPTON PL
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-9284
Practice Address - Country:US
Practice Address - Phone:989-252-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist