Provider Demographics
NPI:1366314684
Name:MICHAEL, MAKENZIE (MS)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5770
Mailing Address - Country:US
Mailing Address - Phone:618-971-3361
Mailing Address - Fax:
Practice Address - Street 1:1912 OLD HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-5676
Practice Address - Country:US
Practice Address - Phone:402-296-3361
Practice Address - Fax:402-296-2667
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20250012193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist