Provider Demographics
NPI:1639728421
Name:HEINSELMAN, MCKENZI ALLISON (SLP)
Entity Type:Individual
Prefix:
First Name:MCKENZI
Middle Name:ALLISON
Last Name:HEINSELMAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 RAVINE CT
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3745
Mailing Address - Country:US
Mailing Address - Phone:330-240-6145
Mailing Address - Fax:
Practice Address - Street 1:349 CHESTERVILLE AVE
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9217
Practice Address - Country:US
Practice Address - Phone:330-240-6145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND.20191200.SP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist