Provider Demographics
NPI:1063940161
Name:HEATH, MACKENZEE (SLP-CCC)
Entity type:Individual
Prefix:
First Name:MACKENZEE
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CHAPMAN CT
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2927
Mailing Address - Country:US
Mailing Address - Phone:907-374-1686
Mailing Address - Fax:866-308-4995
Practice Address - Street 1:140 CHAPMAN CT
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2927
Practice Address - Country:US
Practice Address - Phone:907-374-1686
Practice Address - Fax:866-308-4995
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK115325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist