Healthcare Provider Details

I. General information

NPI: 1700796547
Provider Name (Legal Business Name): MAKENZIE ROCHELLE RIVAS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 TOWER BLVD
LORAIN OH
44052-5223
US

IV. Provider business mailing address

760 TOWER BLVD
LORAIN OH
44052-5223
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-4277
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number16940
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: