Provider Demographics
NPI:1528940228
Name:GULKA, MACKENZIE BETH
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:BETH
Last Name:GULKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7951 W BEARDSLEY RD UNIT 10302
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2738
Mailing Address - Country:US
Mailing Address - Phone:306-562-7914
Mailing Address - Fax:
Practice Address - Street 1:14002 W MEEKER BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5201
Practice Address - Country:US
Practice Address - Phone:623-584-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP16446235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist