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NPI Code Detail

MEDICARE: MACKENZIE BASS

MEDICARE: MACKENZIE BASS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1336988310
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE BASS
Provider Business Mailing Address
First Line : 768 SILVERGLADE AVE W
Second Line :
City : DELANO
State : MN
Zip : 55328-1301
Country : US
Telephone Number : 651-447-9159
Fax Number :
Provider Business Practice Location Address
First Line : 4255 LEXINGTON AVE N
Second Line :
City : ARDEN HILLS
State : MN
Zip : 55126-6164
Country : US
Telephone Number : 535-095-2746
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2024
Last Update Date : 01/28/2026

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Directions to “ MACKENZIE BASS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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