Provider Demographics
NPI:1548744238
Name:PHILLIPS, MACKENZIE (AUD)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 BLUE MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-9085
Mailing Address - Country:US
Mailing Address - Phone:970-218-0777
Mailing Address - Fax:
Practice Address - Street 1:200 PLAZA DR STE 110
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2348
Practice Address - Country:US
Practice Address - Phone:720-627-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000939231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist