Provider Demographics
NPI:1255901849
Name:BRYAN, MACKENZIE ELIZABETH (AUD, CCC-A)
Entity type:Individual
Prefix:DR
First Name:MACKENZIE
Middle Name:ELIZABETH
Last Name:BRYAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:ELIZABETH
Other - Last Name:THAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:793 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2543
Mailing Address - Country:US
Mailing Address - Phone:901-310-5983
Mailing Address - Fax:
Practice Address - Street 1:793 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2543
Practice Address - Country:US
Practice Address - Phone:901-310-5983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2056OtherAUDIOLOGY LICENSE