Healthcare Provider Details

I. General information

NPI: 1780592519
Provider Name (Legal Business Name): MACKENZIE JO PERHACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GIST RD
WESTMINSTER MD
21157-5754
US

IV. Provider business mailing address

220 BENNETT CT
THURMONT MD
21788-2282
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-3650
  • Fax:
Mailing address:
  • Phone: 301-606-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number03250L
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: