Provider Demographics
NPI:1841444932
Name:DAVIS, MCKENZIE (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:WINCHESTER
Other - Last Name:BICKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:199 STATE ST
Mailing Address - Street 2:#2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-8705
Mailing Address - Country:US
Mailing Address - Phone:917-648-5074
Mailing Address - Fax:
Practice Address - Street 1:199 STATE ST
Practice Address - Street 2:#2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-8705
Practice Address - Country:US
Practice Address - Phone:917-648-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015628-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist