Provider Demographics
NPI:1881282457
Name:RECK, MCKENZIE MICHELLE
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:MICHELLE
Last Name:RECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 HALYDAY RUN RD
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-4701
Mailing Address - Country:US
Mailing Address - Phone:814-758-1195
Mailing Address - Fax:
Practice Address - Street 1:2574 HOGBACK HILL
Practice Address - Street 2:
Practice Address - City:MINERAL SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:16855
Practice Address - Country:US
Practice Address - Phone:814-762-4426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0010724235Z00000X
PASL016491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist