Provider Demographics
NPI:1346069713
Name:HUNT, MACKENZIE ALLISON (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ALLISON
Last Name:HUNT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:MACKENZIE
Other - Middle Name:ALLISON
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:2112 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1915
Mailing Address - Country:US
Mailing Address - Phone:909-801-1323
Mailing Address - Fax:
Practice Address - Street 1:2112 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1915
Practice Address - Country:US
Practice Address - Phone:909-801-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30999235Z00000X
AZSLP15707235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist