Healthcare Provider Details

I. General information

NPI: 1205798089
Provider Name (Legal Business Name): MACKENZIE GRACE DAVIS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5321 CARNEGIE ST APT 1
PITTSBURGH PA
15201-2512
US

IV. Provider business mailing address

5321 CARNEGIE ST APT 1
PITTSBURGH PA
15201-2512
US

V. Phone/Fax

Practice location:
  • Phone: 814-564-0122
  • Fax:
Mailing address:
  • Phone: 814-564-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL018774
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: