Provider Demographics
NPI:1952893505
Name:MARSHALL, MCKENZIE (ST)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 W MARKHAM ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72201-1306
Mailing Address - Country:US
Mailing Address - Phone:501-447-1000
Mailing Address - Fax:
Practice Address - Street 1:810 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72201-1306
Practice Address - Country:US
Practice Address - Phone:501-447-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
AR200517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist