Healthcare Provider Details

I. General information

NPI: 1184230757
Provider Name (Legal Business Name): MCKENZIE RAE MENGELE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENZIE DAILEY CCC-SLP

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 BALLENGER CENTER DR STE 102
FREDERICK MD
21703-7384
US

IV. Provider business mailing address

2305 CONNOR CIR
MOUNT AIRY MD
21771-5959
US

V. Phone/Fax

Practice location:
  • Phone: 301-301-9399
  • Fax:
Mailing address:
  • Phone: 410-736-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number09818
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: