Provider Demographics
NPI:1851910434
Name:ADAMS, MCKENZIE ANNE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ANNE
Last Name:ADAMS
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 1:16201 STERLING CANYON DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-3005
Mailing Address - Country:US
Mailing Address - Phone:405-620-3046
Mailing Address - Fax:
Practice Address - Street 1:2429 WESTPORT DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6337
Practice Address - Country:US
Practice Address - Phone:405-308-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist