Provider Demographics
NPI:1952065518
Name:BROTHERS, MCKENZIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PHEASANT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-1819
Mailing Address - Country:US
Mailing Address - Phone:386-366-4951
Mailing Address - Fax:
Practice Address - Street 1:403 PHEASANT RIDGE DR
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-1819
Practice Address - Country:US
Practice Address - Phone:386-366-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14130126OtherASHA CERTIFICATE OF CLINICAL COMPETENCE
SC7257OtherSTATE OF SOUTH CAROLINA DEPARTMENT OF LABOR, LICENSING AND REGULATION