Provider Demographics
NPI:1992551246
Name:MERCER, MCKENZIE JAELYNN
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:JAELYNN
Last Name:MERCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3382 E ARIS DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4213
Mailing Address - Country:US
Mailing Address - Phone:970-623-5866
Mailing Address - Fax:
Practice Address - Street 1:60 E RIO SALADO PKWY STE 900
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-9126
Practice Address - Country:US
Practice Address - Phone:970-623-5866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122024235Z00000X
AZSLP15847235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist