Provider Demographics
NPI:1578279147
Name:HESLEP, MCKENZIE LYN (MCD)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LYN
Last Name:HESLEP
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 GABRIEL CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8676
Mailing Address - Country:US
Mailing Address - Phone:501-425-7171
Mailing Address - Fax:
Practice Address - Street 1:146 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4077
Practice Address - Country:US
Practice Address - Phone:870-520-8761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist