Provider Demographics
NPI:1538881784
Name:GLOSSER, MACKENZIE RAE (MS)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:RAE
Last Name:GLOSSER
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 1:6125 E BELKNAP ST
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76117-4204
Mailing Address - Country:US
Mailing Address - Phone:817-547-5700
Mailing Address - Fax:
Practice Address - Street 1:6125 E BELKNAP ST
Practice Address - Street 2:
Practice Address - City:HALTOM CITY
Practice Address - State:TX
Practice Address - Zip Code:76117-4204
Practice Address - Country:US
Practice Address - Phone:817-547-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist