Provider Demographics
NPI:1972804722
Name:MACKENZIE, HEIDI ANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANNE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E JEFFERSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5644
Mailing Address - Country:US
Mailing Address - Phone:206-320-5687
Mailing Address - Fax:206-320-8145
Practice Address - Street 1:1600 E JEFFERSON ST STE 202
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5644
Practice Address - Country:US
Practice Address - Phone:206-320-5687
Practice Address - Fax:206-320-8145
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD 00002097231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist