Individual
MACKENZIE JOHN IWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.-C.F.
Contact information
Practice address
3613 S 13TH ST, SHEBOYGAN, WI 53081-7253
(920) 458-4040
(920) 208-2982
Mailing address
6520 W ENGLISH MEADOWS DR APT I102, GREENFIELD, WI 53220-3969
(414) 526-7326
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3630-154
WI
Other
Enumeration date
03/07/2012
Last updated
03/07/2012
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