Individual
MRS. MACKENZIE L SWENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
266 JILL DR, REXBURG, ID 83440-5325
(208) 419-3539
Mailing address
266 JILL DR, REXBURG, ID 83440-5325
(208) 419-3539
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1949
ID
Other
Enumeration date
03/03/2010
Last updated
03/03/2010
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