Active NPI
Mackenzie M McCollam, SLP, M.S.
- Speech-Language Pathologist
- Spokane Valley, WA
National Provider Identifier
1326470261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SI 60402274
- Practice address
- 2510 N Pines Rd Ste 3
Spokane Valley, WA 99206-7636 - Phone
- (509) 315-5711
- NPI assigned
- Aug 2, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SI 60402274 | WA | Primary |
Addresses
Primary practice location
2510 N Pines Rd Ste 3
Spokane Valley, WA 99206-7636
Mailing address
22512 E Heroy Ave
Otis Orchards, WA 99027-9316
Phone (509) 954-5876
Other practice location 1
11623 Arbor St
Omaha, NE 68144-2981
Phone (402) 334-6019
Other names 1
- Ms. Mackenzie M Johnson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SI 60402274 | WA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Children Family Intervention Respit Services and Therapy | Speech-Language Pathologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatric Physical Therapist
- Spokane Valley, WA
- NPI 1265591275
Speech-Language Pathologist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528761600000",
"number": "1326470261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22512 E HEROY AVE",
"city": "OTIS ORCHARDS",
"state": "WA",
"postal_code": "990279316",
"telephone_number": "509-954-5876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2510 N PINES RD STE 3",
"city": "SPOKANE VALLEY",
"state": "WA",
"postal_code": "992067636",
"telephone_number": "509-315-5711"
}
],
"practiceLocations": [
{
"address_1": "11623 Arbor St",
"address_purpose": "LOCATION",
"city": "Omaha",
"state": "NE",
"postal_code": "681442981",
"country_code": "US",
"telephone_number": "402-334-6019",
"fax_number": "402-334-6844",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MCCOLLAM",
"first_name": "MACKENZIE",
"middle_name": "M",
"name_prefix": "Mrs.",
"credential": "SLP, M.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-02",
"last_updated": "2018-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WA",
"license": "SI 60402274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MACKENZIE",
"last_name": "JOHNSON",
"middle_name": "M",
"prefix": "MS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Spokane Valley, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.