Provider Demographics
NPI:1952909715
Name:STRUEMPH, MAKENZIE NICOLE (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:NICOLE
Last Name:STRUEMPH
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 ROLLING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MO
Mailing Address - Zip Code:63025-4146
Mailing Address - Country:US
Mailing Address - Phone:314-541-2340
Mailing Address - Fax:
Practice Address - Street 1:4630 BRENNAN RD
Practice Address - Street 2:
Practice Address - City:HIGH RIDGE
Practice Address - State:MO
Practice Address - Zip Code:63049-1801
Practice Address - Country:US
Practice Address - Phone:636-677-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020017771235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist