McKenzie Brazile, MS CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Clovis, NM
NPI 1982087664 · NPPES record last updated Jun 30, 2015
Key facts
- NPI
- 1982087664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 104948 (TX)
- Practice address
- 2221 Dillon Rd
Clovis, NM 88101-9454 - Phone
- (575) 762-4495
- NPI assigned
- Jun 30, 2015
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5491 | NM | MD | Speech-Language Pathologist |
| 104948 | TX | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 104948 | TX | Yes |
| Speech-Language Pathologist | 235Z00000X | 5491 | NM |
Addresses
Primary practice location
2221 Dillon Rd
Clovis, NM 88101-9454
Mailing address
2221 Dillon Rd
Clovis, NM 88101-9454
Other providers in Clovis, NM
- Brittany M Boylan
- Chelsea Bradley
- Samantha L Brady
- Adrienne Bratcher
- Nathan Brault
- Majlis Breath
- Brian a. Zarikta, DDS
- Loveta Rae Briscoe
- Madison Brochu
- Teresa Ladean Broeker
All providers in Clovis, NM · Speech-Language Pathologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.