Individual
MRS. JENNIFER LEA MCKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
2840 SECKMAN RD, IMPERIAL, MO 63052-1941
(636) 296-5707
Mailing address
1532 PREHISTORIC HILL DR, IMPERIAL, MO 63052-2288
(314) 805-0477
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2011041709
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235Z00000X
—
MO
Enumeration date
09/18/2018
Last updated
09/18/2018
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