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General NPI Number Information
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NPI Number | 1386590172
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Entity Type | Individual
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Provider Name | MCKINZIE MARIE SALOMAKI CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 618 BAKERTOWN RD
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City | SULLIVAN
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State | WI
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Zip | 53178-9769
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Country | US
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Telephone | 920-674-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 839 MARY CT
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City | JEFFERSON
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State | WI
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Zip | 53549-1825
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Country | US
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Telephone | 920-728-5759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 14393639
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License Number State | WI
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