Provider Demographics
NPI:1174141139
Name:SIZEMORE, MCKENZIE DANEE
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:DANEE
Last Name:SIZEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 LULLWATER DR UNIT 1425
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6620
Mailing Address - Country:US
Mailing Address - Phone:205-412-0853
Mailing Address - Fax:
Practice Address - Street 1:7130 HODGSON MEMORIAL DR STE 100
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1527
Practice Address - Country:US
Practice Address - Phone:205-412-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist