Healthcare Provider Details

I. General information

NPI: 1679270839
Provider Name (Legal Business Name): MCKENZIE LOWERY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 E MUSKEGON ST
CEDAR SPRINGS MI
49319-9599
US

IV. Provider business mailing address

7388 ADARE CIR
GRAND LEDGE MI
48837-8153
US

V. Phone/Fax

Practice location:
  • Phone: 616-696-9102
  • Fax:
Mailing address:
  • Phone: 517-231-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101008771
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: