Provider Demographics
NPI:1538659925
Name:SOBCHUK, MACKENZIE CLAIRE
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:CLAIRE
Last Name:SOBCHUK
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 1:7233 FLINT POND CIR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4714
Mailing Address - Country:US
Mailing Address - Phone:860-916-8441
Mailing Address - Fax:
Practice Address - Street 1:238 LITTLETON RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3529
Practice Address - Country:US
Practice Address - Phone:978-496-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MA77170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist