MEDICARE: MACKENZIE NORTHRUP AUD

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	231H00000X	Audiologist

General Provider Information

NPI Number	:	1588524433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE NORTHRUP AUD

Provider Business Mailing Address
First Line	:	5127 COUNTRYSIDE ST NE APT 303
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-4194
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5127 COUNTRYSIDE ST NE APT 303
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97305-4194
Country	:	US
Telephone Number	:	801-598-2204
Fax Number	:

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

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	02/05/2026

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Directions to “ MACKENZIE NORTHRUP AUD” Practice Location

Language	Start Address	Practice Location

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