Mackenzie Marie Wittrock, MA, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

081047 Issued in IA

Practice address

408 W 8TH St
Carroll, IA 51401-2325

Phone

(712) 210-4302

NPI assigned

Dec 1, 2023

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 Marie Stork Former name

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

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.

• Speech Pathways, LLC

  • Speech-Language Pathologist
  • Carroll, IA
  • NPI 1770359564
  Medicare reassignment NPD Authorized official
• Adaptive Audiology Solutions PC

  • Audiologist
  • Carroll, IA
  • NPI 1073083077
  NPD

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

{
    "created_epoch": "1701388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701388800000",
    "number": "1528834389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 QUINT AVE",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514013566",
            "telephone_number": "712-210-4302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 W 8TH ST",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514012325",
            "telephone_number": "712-210-4302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITTROCK",
        "first_name": "MACKENZIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MA, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-12-01",
        "last_updated": "2023-12-01",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IA",
            "license": "081047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "STORK",
            "middle_name": "MARIE",
            "credential": "MA, CF-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shelby Lynn White
• Wiederin Construction LLC
• Daniel Nic Wilhelmi, DDS
• Abby M.H. Williams, DPM
• Joshua J. Williams, DO

• Speech-Language Pathologist in Carroll, IA
• Providers in Carroll, IA by specialty
• Speech-Language Pathologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.