Provider Demographics
NPI:1457704710
Name:MCKENZIE, MILLER ANN (AUD)
Entity type:Individual
Prefix:
First Name:MILLER
Middle Name:ANN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MILLER
Other - Middle Name:
Other - Last Name:MCINNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15280 NW 79TH CT STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5873
Mailing Address - Country:US
Mailing Address - Phone:305-558-3724
Mailing Address - Fax:
Practice Address - Street 1:3 PINE CONE DR STE 105
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8684
Practice Address - Country:US
Practice Address - Phone:386-597-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2032231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist