Provider Demographics
NPI:1730065616
Name:DEWITZ, MAKENNA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:
Last Name:DEWITZ
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 E FAULKNER ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5837
Mailing Address - Country:US
Mailing Address - Phone:936-404-3273
Mailing Address - Fax:
Practice Address - Street 1:500 ZAVALA TRL
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3124
Practice Address - Country:US
Practice Address - Phone:936-404-3273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122869235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist