Provider Demographics
NPI:1457147969
Name:MACKENZIE RENNER MS CCC-SLP LLC
Entity type:Organization
Organization Name:MACKENZIE RENNER MS CCC-SLP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LEAD SLP
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:949-292-1465
Mailing Address - Street 1:95-128 KIPAPA DR APT 404
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1174
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95-128 KIPAPA DR APT 404
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-1174
Practice Address - Country:US
Practice Address - Phone:949-292-1465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty