Provider Demographics
NPI:1841047206
Name:HYMAS, MACKENZIE JO (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JO
Last Name:HYMAS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:COTTRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8406 W. WHITE QUEST DRIVE
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84013
Mailing Address - Country:US
Mailing Address - Phone:801-335-4699
Mailing Address - Fax:801-335-7031
Practice Address - Street 1:8406 W. WHITE QUEST DRIVE
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84013
Practice Address - Country:US
Practice Address - Phone:801-335-4699
Practice Address - Fax:801-335-7031
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13918157-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist