Provider Demographics
NPI:1639881196
Name:BADICK, MACKENZIE LISA
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LISA
Last Name:BADICK
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 1:7 MERIWETHER TRL
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1846
Mailing Address - Country:US
Mailing Address - Phone:845-893-3844
Mailing Address - Fax:
Practice Address - Street 1:501 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-5600
Practice Address - Country:US
Practice Address - Phone:845-638-3072
Practice Address - Fax:845-638-3073
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031960235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist