Provider Demographics
NPI:1912450990
Name:DESJARLAIS, MCKENZIE (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:DESJARLAIS
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18250 142ND AVE NE
Mailing Address - Street 2:APT 202
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4361
Mailing Address - Country:US
Mailing Address - Phone:509-953-6497
Mailing Address - Fax:
Practice Address - Street 1:340 E SUNSET WAY
Practice Address - Street 2:#101
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3474
Practice Address - Country:US
Practice Address - Phone:425-557-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI 60667033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist