Individual
ALICIA MCKENZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S. CCC-SLP
Contact information
Practice address
1013 ENON CT, ST AUGUSTINE, FL 32092-0431
(904) 940-4795
Mailing address
1013 ENON CT, ST AUGUSTINE, FL 32092-0431
(904) 940-4795
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA 9049
FL
252Y00000X
Early Intervention Provider Agency
—
—
372600000X
Adult Companion
—
—
376J00000X
Homemaker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000828900
—
FL
05
—
001689700
—
FL
Enumeration date
10/28/2008
Last updated
10/23/2012
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