Provider Demographics
NPI:1447932603
Name:HARRIS, MAKENZIE LAUREN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:LAUREN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W CIRCUIT DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6409
Mailing Address - Country:US
Mailing Address - Phone:409-659-5119
Mailing Address - Fax:
Practice Address - Street 1:165 W CIRCUIT DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6409
Practice Address - Country:US
Practice Address - Phone:409-659-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist