Healthcare Provider Details

I. General information

NPI: 1386579803
Provider Name (Legal Business Name): MRS. MAKENNA LOU FLEMING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MAKENNA LOU BAULDRY

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W HIGHLAND RD
HOWELL MI
48843-2168
US

IV. Provider business mailing address

2140 HAWTHORN MDWS
HOWELL MI
48843-9743
US

V. Phone/Fax

Practice location:
  • Phone: 517-376-4831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number14527057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: