Provider Demographics
NPI:1023745049
Name:HAMILTON, MACKENZIE GRACE
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:GRACE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7561 S 145TH ST
Mailing Address - Street 2:UNIT 3229
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138
Mailing Address - Country:US
Mailing Address - Phone:402-889-0822
Mailing Address - Fax:
Practice Address - Street 1:423 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2668
Practice Address - Country:US
Practice Address - Phone:402-898-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist