Provider Demographics
NPI:1457121873
Name:HABEL, MCKENZIE MARGARET (CCC-SLP/L)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:MARGARET
Last Name:HABEL
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:SUMMIT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18250-1029
Mailing Address - Country:US
Mailing Address - Phone:570-778-3013
Mailing Address - Fax:
Practice Address - Street 1:397 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-9712
Practice Address - Country:US
Practice Address - Phone:570-386-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL017411235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty