Provider Demographics
NPI:1306565940
Name:HARDY, MACKENZIE EILEEN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:EILEEN
Last Name:HARDY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26211 PASEO MANANA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3418
Mailing Address - Country:US
Mailing Address - Phone:253-797-7617
Mailing Address - Fax:
Practice Address - Street 1:1 AMISTAD DR
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694-1897
Practice Address - Country:US
Practice Address - Phone:949-979-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist