Provider Demographics
NPI:1528721040
Name:BELIERA, MACKENZIE PAIGE (SLP-A)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:PAIGE
Last Name:BELIERA
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 OLYMPIA LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-7076
Mailing Address - Country:US
Mailing Address - Phone:316-305-2522
Mailing Address - Fax:
Practice Address - Street 1:3248 S PRESTON RD STE 130
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3907
Practice Address - Country:US
Practice Address - Phone:214-851-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2355S0801X
TX420292355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty