Individual
MACKENZIE ROSAMOND COLLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S. CF-SLP
Contact information
Practice address
568 BLUE RIDGE DR, EVANS, GA 30809-3604
(706) 364-5262
Mailing address
568 BLUE RIDGE DR, EVANS, GA 30809-3604
(706) 364-5262
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
PCET003930
GA
Other
Enumeration date
09/11/2023
Last updated
09/11/2023
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