Doctor Name: | MAKENZIE MILLDRUM |
NPI Number: | 1285042358 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 19586 |
Business Practice Address: | 1972 Del Paso Rd Suite 156 Sacramento, CA - 958347724 |
Business Phone Number: | 9165758800 |
Business Fax Number: | 9165758822 |
Mailing Address: | 1972 Del Paso Rd, Suite 156 SACRAMENTO |
State: | CA |
Postal Code: | 958347724 |
Phone Number: | 9165758800 |
Fax Number: | 9165758822 |
NPI Enumeration Date: | 08/01/2014 |
NPI Last Update Date: | 08/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 19586 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |