Provider Demographics
NPI:1881061463
Name:BLAIR, MCKENZIE KAY (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MCKENZIE
Middle Name:KAY
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:510 SAINT MARYS AVE
Mailing Address - Street 2:
Mailing Address - City:CAREY
Mailing Address - State:OH
Mailing Address - Zip Code:43316-9584
Mailing Address - Country:US
Mailing Address - Phone:419-721-7546
Mailing Address - Fax:
Practice Address - Street 1:103 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:CAREY
Practice Address - State:OH
Practice Address - Zip Code:43316-1230
Practice Address - Country:US
Practice Address - Phone:419-396-0105
Practice Address - Fax:419-396-0137
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP. 11170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist