Healthcare Provider Details

I. General information

NPI: 1891948469
Provider Name (Legal Business Name): ALICIA MCKENZIE M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 ENON CT
ST AUGUSTINE FL
32092-0431
US

IV. Provider business mailing address

1013 ENON CT
ST AUGUSTINE FL
32092-0431
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-4795
  • Fax:
Mailing address:
  • Phone: 904-940-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 9049
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: