Provider Demographics
NPI:1912190802
Name:MCKENZIE, TERRI (MS CLL-SLP)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MS CLL-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-326-2911
Mailing Address - Fax:217-344-8047
Practice Address - Street 1:810 W. ANTHONY DR
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-7431
Practice Address - Country:US
Practice Address - Phone:217-326-2911
Practice Address - Fax:217-344-8047
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL113326OtherHEALTHLINK PROVIDER ID
IL203OtherBLUE CROSS PROVIDER ID
IL4117OtherHAMP PROVIDER ID
IL7216OtherPERSONALCARE PROVIDER ID
IL203OtherBLUE CROSS PROVIDER ID