Healthcare Provider Details

I. General information

NPI: 1740100429
Provider Name (Legal Business Name): MAKENZIE WILCOX SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W SCIOTO ST
COMMERCIAL POINT OH
43116-9712
US

IV. Provider business mailing address

20 BAZLER LN
SOUTH BLOOMFIELD OH
43103-9235
US

V. Phone/Fax

Practice location:
  • Phone: 614-565-3746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP.15620
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: