Provider Demographics
NPI:1871227025
Name:WICKS, MAKENZIE K (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:K
Last Name:WICKS
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 1:92 HACKETT BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1525
Mailing Address - Country:US
Mailing Address - Phone:802-681-8556
Mailing Address - Fax:
Practice Address - Street 1:92 HACKETT BLVD APT 1
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1525
Practice Address - Country:US
Practice Address - Phone:802-681-8556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist