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General NPI Number Information
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NPI Number | 1558714337
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Entity Type | Individual
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Provider Name | JENNA MACKENZIE M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 1101 CHESTNUT ST FL 16
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City | PHILADELPHIA
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State | PA
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Zip | 19107-3612
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Country | US
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Telephone | 215-955-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 MERTON MINTER ST SPEECH PATHOLOGY AND AUDIOLOGY DEPT
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4404
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Country | US
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Telephone | 210-617-5300
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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 | 111874
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SL016316
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS01348300
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License Number State | NJ
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