Healthcare Provider Details

I. General information

NPI: 1285413047
Provider Name (Legal Business Name): MACKENZIE ELIZABETH HUGHES SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 OLD JACKSBORO HWY STE 101
WICHITA FALLS TX
76302-2700
US

IV. Provider business mailing address

4309 OLD JACKSBORO HWY STE 101
WICHITA FALLS TX
76302-2700
US

V. Phone/Fax

Practice location:
  • Phone: 940-386-1004
  • Fax: 940-386-9944
Mailing address:
  • Phone: 940-386-1004
  • Fax: 940-386-9944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number42749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: