MEDICARE: MAKENZIE GIFT

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
1	235Z00000X	Speech-Language Pathologist	1040324	MN

General Provider Information

NPI Number	:	1538005426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENZIE GIFT

Provider Business Mailing Address
First Line	:	6262 146TH AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-8946
Country	:	US
Telephone Number	:	616-403-5480
Fax Number	:

Provider Business Practice Location Address
First Line	:	21697 STATE HIGHWAY 56
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-5830
Country	:	US
Telephone Number	:	507-857-1160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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Directions to “ MAKENZIE GIFT ” Practice Location

Language	Start Address	Practice Location

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