Healthcare Provider Details

I. General information

NPI: 1700481207
Provider Name (Legal Business Name): HANNAH MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 KIMES LN
ATHENS OH
45701-3899
US

IV. Provider business mailing address

510 W MAIN ST
CANFIELD OH
44406-1454
US

V. Phone/Fax

Practice location:
  • Phone: 740-593-3391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberCOND.20201369-SP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: