Healthcare Provider Details

I. General information

NPI: 1366363715
Provider Name (Legal Business Name): MACKENZIE LYNN HEENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MACKENZIE LYNN KREBILL

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NW VESPER ST
BLUE SPRINGS MO
64015-3219
US

IV. Provider business mailing address

213 NE CHATEAU DR
BLUE SPRINGS MO
64014-2625
US

V. Phone/Fax

Practice location:
  • Phone: 816-874-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2025034676
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: