Active NPI
Makenzie Mayall
- Speech-Language Pathologist
- Canton, IL
National Provider Identifier
1962014977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242006074
- Practice address
- 1605 E Ash St
Canton, IL 61520-1510 - Phone
- (309) 647-6951
- NPI assigned
- Aug 20, 2020
- 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 | 242006074 | IL | Primary |
Addresses
Primary practice location
1605 E Ash St
Canton, IL 61520-1510
Mailing address
1605 E Ash St
Canton, IL 61520-1510
Phone (309) 647-6951
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242006074 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630627200000",
"number": "1962014977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1605 E ASH ST",
"city": "CANTON",
"state": "IL",
"postal_code": "615201510",
"telephone_number": "309-647-6951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1605 E ASH ST",
"city": "CANTON",
"state": "IL",
"postal_code": "615201510",
"telephone_number": "309-647-6951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYALL",
"first_name": "MAKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-20",
"last_updated": "2021-09-03",
"certification_date": "2021-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242006074",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.