Provider Demographics
NPI:1568135879
Name:BARNES, MACKENZIE BETH
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:BETH
Last Name:BARNES
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 1:1 WALLACE FARMS LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-5137
Mailing Address - Country:US
Mailing Address - Phone:540-903-6859
Mailing Address - Fax:
Practice Address - Street 1:107 NORTHAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7660
Practice Address - Country:US
Practice Address - Phone:540-658-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist