Individual
MACKENZIE LANDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1321 W 7TH AVE, STILLWATER, OK 74074-4360
(405) 372-8200
Mailing address
1023 S GRAY ST, STILLWATER, OK 74074-5445
(405) 332-6410
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
CF185
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14179439
ASHA
—
01
—
CF185
OK BOARD OF EXAMINERS
OK
Enumeration date
04/29/2020
Last updated
04/29/2020
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