Individual
MECKENZIE HORBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
503 S 18TH ST, LARAMIE, WY 82070-4303
(307) 742-3728
Mailing address
503 S 18TH ST, LARAMIE, WY 82070-4391
(563) 340-7301
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
146.011323
IL
235Z00000X
Speech-Language Pathologist
Primary
SP-1273
WY
235Z00000X
Speech-Language Pathologist
SP.10780
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215875
ASHA
—
01
—
1460011232
ILLINOIS LICENSE
IL
01
—
SP-1273
WYOMING LICENSE
WY
Enumeration date
06/19/2013
Last updated
07/25/2022
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