Provider Demographics
NPI:1902322076
Name:GOBLE, MAKENZIE ALICEN (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:ALICEN
Last Name:GOBLE
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:ALICEN
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CF-SLP
Mailing Address - Street 1:7 NE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASEY
Mailing Address - State:IL
Mailing Address - Zip Code:62420-1628
Mailing Address - Country:US
Mailing Address - Phone:618-302-1400
Mailing Address - Fax:
Practice Address - Street 1:100 NE 15TH ST
Practice Address - Street 2:
Practice Address - City:CASEY
Practice Address - State:IL
Practice Address - Zip Code:62420-2152
Practice Address - Country:US
Practice Address - Phone:217-932-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-20
Last Update Date:2017-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242004407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist