Healthcare Provider Details

I. General information

NPI: 1558278994
Provider Name (Legal Business Name): MACKENZIE DANIELLE ROSENLEAF M.S. CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E STUART ST STE 3120
FORT COLLINS CO
80525-1196
US

IV. Provider business mailing address

1136 E STUART ST STE 3120
FORT COLLINS CO
80525-1196
US

V. Phone/Fax

Practice location:
  • Phone: 970-682-3743
  • Fax:
Mailing address:
  • Phone: 970-682-3743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPSLP.0001650
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: