| Doctor Name: | MACKENZIE JOHN IWEN |
| NPI Number: | 1730453770 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S.-C.F. |
| License Number: | 3630-154 |
| Business Practice Address: | 3613 S 13th St Sheboygan, WI - 530817253 |
| Business Phone Number: | 9204584040 |
| Business Fax Number: | 9202082982 |
| Mailing Address: | 6520 W English Meadows Dr Apt I102, GREENFIELD |
| State: | WI |
| Postal Code: | 532203969 |
| Phone Number: | 4145267326 |
| Fax Number: | |
| NPI Enumeration Date: | 03/07/2012 |
| NPI Last Update Date: | 03/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3630-154 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| 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 |