Provider Demographics
NPI:1760119028
Name:MCKENZIE, MADELINE C (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:C
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11955 EPPING TRL
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-8849
Mailing Address - Country:US
Mailing Address - Phone:440-376-0144
Mailing Address - Fax:
Practice Address - Street 1:711 E 222ND ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2033
Practice Address - Country:US
Practice Address - Phone:440-376-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14903235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist