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General NPI Number Information
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NPI Number | 1639728421
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Entity Type | Individual
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Provider Name | MCKENZI ALLISON HEINSELMAN SLP
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Gender | Female
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 349 CHESTERVILLE AVE
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City | CARDINGTON
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State | OH
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Zip | 43315-9217
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Country | US
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Telephone | 330-240-6145
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 RAVINE CT
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City | NILES
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State | OH
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Zip | 44446-3745
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Country | US
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Telephone | 330-240-6145
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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 | COND.20191200.SP
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License Number State | OH
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