MEDICARE: MEKENZI E PECK SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4295	OK

General Provider Information

NPI Number	:	1063816890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEKENZI E PECK SLP

Provider Business Mailing Address
First Line	:	6201 N SANTA FE AVE STE 1000
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7532
Country	:	US
Telephone Number	:	405-272-7425
Fax Number	:	405-272-7039

Provider Business Practice Location Address
First Line	:	6201 N SANTA FE AVE STE 1000
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-7532
Country	:	US
Telephone Number	:	405-272-7425
Fax Number	:	405-272-7039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	03/26/2024

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Directions to “ MEKENZI E PECK SLP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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