Healthcare Provider Details

I. General information

NPI: 1740935568
Provider Name (Legal Business Name): M'KENZIE CRAVENS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3597 KESWICK DR
CHAMBLEE GA
30341-2003
US

IV. Provider business mailing address

1102 WAKE DR
RICHARDSON TX
75081-3723
US

V. Phone/Fax

Practice location:
  • Phone: 678-585-4715
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: