Active NPI
McKenzye Jane Anderson, MS, CCC-SLP
- Speech-Language Pathologist
- Flagstaff, AZ
National Provider Identifier
1942389853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP4251
- Practice address
- 1805 W. Heavenly CT.
Flagstaff, AZ 86001 - Phone
- (928) 226-1563
- Fax
- (928) 526-0158
- NPI assigned
- Nov 2, 2006
- Last updated
- Feb 19, 2009
- 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 | SLP4251 | AZ | Primary |
Addresses
Primary practice location
1805 W. Heavenly CT.
Flagstaff, AZ 86001
Mailing address
PO Box 3830
Flagstaff, AZ 86003
Phone (928) 226-1563
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SLP4251 | Other | AZ | AZ DHS LICENSE |
| 834285 | Other | AZ | AHCCCS # |
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 |
|---|---|---|---|
| SLP4251 | AZ | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Interventions of Arizona, LLC | Speech-Language Pathologist | Past | Accepting new patients |
| Dynamic Interventions of Arizona, LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Speech-Language Pathologist
- Golden Valley, AZ
- NPI 1316191471
-
- Speech-Language Assistant
- Flagstaff, AZ
- NPI 1578003943
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235001600000",
"number": "1942389853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3830",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "86003",
"telephone_number": "928-226-1563",
"fax_number": "928-526-0158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1805 W. HEAVENLY CT.",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "86001",
"telephone_number": "928-226-1563",
"fax_number": "928-526-0158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "MCKENZYE",
"middle_name": "JANE",
"name_prefix": "Mrs.",
"credential": "MS, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-02",
"last_updated": "2009-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "AZ",
"license": "SLP4251",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AZ DHS LICENSE",
"identifier": "SLP4251",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AHCCCS #",
"identifier": "834285",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.