Individual
DIANE MCKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1921 BYRON ST SW, KIT CARSON ES, ALBUQUERQUE, NM 87105-4512
(505) 877-2724
Mailing address
1921 BYRON ST SW, KIT CARSON ES, ALBUQUERQUE, NM 87105-4512
(505) 877-2724
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2350
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
54709059
—
NM
Enumeration date
02/28/2007
Last updated
07/09/2007
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