Provider Demographics
NPI:1306576483
Name:EBEL, MCKENZIE LYNN
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LYNN
Last Name:EBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SW 10TH ST APT 1501
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4142
Mailing Address - Country:US
Mailing Address - Phone:815-715-9912
Mailing Address - Fax:
Practice Address - Street 1:1 OAKWOOD BLVD STE 130
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-1937
Practice Address - Country:US
Practice Address - Phone:954-925-3844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist