Provider Demographics
NPI:1124764733
Name:MOYERS, MACKENZIE LYNN (SLP-CCC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LYNN
Last Name:MOYERS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:LYNN
Other - Last Name:RAWLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:2763 N 3870 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7548
Mailing Address - Country:US
Mailing Address - Phone:208-206-3920
Mailing Address - Fax:
Practice Address - Street 1:2763 N 3870 W
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7548
Practice Address - Country:US
Practice Address - Phone:385-374-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT235Z00000X
UT12905658-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist