Provider Demographics
NPI:1992550370
Name:SMALLEY, MACKENZIE JOLENE (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:JOLENE
Last Name:SMALLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MS
Other - First Name:MACKENZIE
Other - Middle Name:JOLENE
Other - Last Name:MONAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1218 N MARCUS RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1931
Mailing Address - Country:US
Mailing Address - Phone:509-832-1666
Mailing Address - Fax:
Practice Address - Street 1:11703 E SPRAGUE AVE # CTE-3
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6128
Practice Address - Country:US
Practice Address - Phone:509-435-0481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI61435274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist