Provider Demographics
NPI:1588166771
Name:MCKENZIE, JANICE MARIE (CCC/SLP)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:MCKENZIE
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 1:9318 FLANAGAN CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8902
Mailing Address - Country:US
Mailing Address - Phone:703-623-8714
Mailing Address - Fax:
Practice Address - Street 1:8909 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2404
Practice Address - Country:US
Practice Address - Phone:703-365-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007796235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist