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NPI Code Detail

MEDICARE: MRS. MACKENZIE MARIE WITTROCK MA, CCC-SLP

MEDICARE: MRS. MACKENZIE MARIE WITTROCK MA, CCC-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
1235Z00000XSpeech-Language Pathologist081047IA

General Provider Information

NPI Number : 1528834389
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MACKENZIE MARIE WITTROCK MA, CCC-SLP
Provider Business Mailing Address
First Line : 1831 QUINT AVE
Second Line :
City : CARROLL
State : IA
Zip : 51401-3566
Country : US
Telephone Number : 712-210-4302
Fax Number :
Provider Business Practice Location Address
First Line : 408 W 8TH ST
Second Line :
City : CARROLL
State : IA
Zip : 51401-2325
Country : US
Telephone Number : 712-210-4302
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2023
Last Update Date : 12/01/2023

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Directions to “ MRS. MACKENZIE MARIE WITTROCK MA, CCC-SLP” Practice Location

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