Provider Demographics
NPI:1083112296
Name:FARMER, MAKENZI SHADE (MA)
Entity type:Individual
Prefix:MRS
First Name:MAKENZI
Middle Name:SHADE
Last Name:FARMER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MAKENZI
Other - Middle Name:
Other - Last Name:PEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 S SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-1848
Mailing Address - Country:US
Mailing Address - Phone:517-554-0070
Mailing Address - Fax:
Practice Address - Street 1:622 S SHELDON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1848
Practice Address - Country:US
Practice Address - Phone:517-554-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist