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General NPI Number Information
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NPI Number | 1457147969
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Entity Type | Organization
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Legal Business Name | MACKENZIE RENNER MS CCC-SLP LLC
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Dates
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Enumeration Date | 04/19/2025
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Last Update Date | 04/19/2025
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Provider Practice Location Address
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Address Line | 95-128 KIPAPA DR APT 404
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City | MILILANI
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State | HI
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Zip | 96789-1174
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Country | US
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Telephone | 949-292-1465
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Fax |
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Provider Business Mailing Address
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Address Line | 95-128 KIPAPA DR APT 404
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City | MILILANI
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State | HI
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Zip | 96789-1174
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND LEAD SLP
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Name | MACKENZIE RENNER
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Credential | MS CCC-SLP
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Telephone | 949-292-1465
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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 |
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License Number State |
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