Mackenzie Determan, M.S., SLP-CF

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

9284 Issued in MN

Practice address

15620 Edgewood Dr
Ste 240
Baxter, MN 56401-6983

Phone

(218) 454-7012

Fax

(218) 454-7015

NPI assigned

Jun 4, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mackenzie Schorn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420761600000",
    "number": "1396158796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 WASHINGTON AVE",
            "city": "ORTONVILLE",
            "state": "MN",
            "postal_code": "562781357",
            "telephone_number": "320-839-4271",
            "fax_number": "320-839-4196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15620 EDGEWOOD DR",
            "address_2": "STE 240",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564016983",
            "telephone_number": "218-454-7012",
            "fax_number": "218-454-7015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETERMAN",
        "first_name": "MACKENZIE",
        "name_prefix": "Ms.",
        "credential": "M.S., SLP-CF",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-04",
        "last_updated": "2015-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "9284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "SCHORN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Baxter, MN
• Providers in Baxter, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.