Provider Demographics
NPI:1962840280
Name:WHITING, MCKENZIE LEE-WILKIN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MCKENZIE
Middle Name:LEE-WILKIN
Last Name:WHITING
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:LEE
Other - Last Name:WILKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5601 WHITE HORSE DR.
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1323
Mailing Address - Country:US
Mailing Address - Phone:928-380-2343
Mailing Address - Fax:
Practice Address - Street 1:5601 WHITE HORSE DR.
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1323
Practice Address - Country:US
Practice Address - Phone:928-380-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-08
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11445235Z00000X
AZTSLP11445235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist