MEDICARE: MCKENZIE PERKINS

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		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447838727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE PERKINS

Provider Business Mailing Address
First Line	:	33329 HARTSHORN RIDGE RD
Second Line	:
City	:	GRAYSVILLE
State	:	OH
Zip	:	45734-9797
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33329 HARTSHORN RIDGE RD
Second Line	:
City	:	GRAYSVILLE
State	:	OH
Zip	:	45734-9797
Country	:	US
Telephone Number	:	740-567-3312
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	09/26/2022

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Directions to “ MCKENZIE PERKINS ” Practice Location

Language	Start Address	Practice Location

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