MEDICARE: MACKENZIE ELIZABETH ROUNTREE

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	SLP013946	GA
2	235Z00000X	Speech-Language Pathologist	9457	SC
3	235Z00000X	Speech-Language Pathologist	SLP96037	MA

General Provider Information

NPI Number	:	1962100123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE ELIZABETH ROUNTREE

Provider Business Mailing Address
First Line	:	64 SCHOOSETT ST
Second Line	:
City	:	PEMBROKE
State	:	MA
Zip	:	02359-1882
Country	:	US
Telephone Number	:	781-335-6663
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 SHARP ST STE 3
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4334
Country	:	US
Telephone Number	:	781-335-6663
Fax Number	:

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

Provider Enumeration Date	:	02/17/2023
Last Update Date	:	12/23/2025

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Directions to “ MACKENZIE ELIZABETH ROUNTREE ” Practice Location

Language	Start Address	Practice Location

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