1427532399 NPI number — MRS. JENNIFER LEA MCKENZIE M.A. CCC-SLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427532399 NPI number — MRS. JENNIFER LEA MCKENZIE M.A. CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKENZIE
Provider First Name:
JENNIFER
Provider Middle Name:
LEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A. CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELMAR
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A. CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427532399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1532 PREHISTORIC HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMPERIAL
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63052-2288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-805-0477
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2840 SECKMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IMPERIAL
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63052-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-296-5707
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2011041709 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 235Z00000X , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com