Provider Demographics
NPI:1255571329
Name:MCKENZIE, LYNN RULIEN (MS)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:RULIEN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 W. NATIONAL AVE.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227
Mailing Address - Country:US
Mailing Address - Phone:414-755-4968
Mailing Address - Fax:800-882-0886
Practice Address - Street 1:814 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589
Practice Address - Country:US
Practice Address - Phone:608-873-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3202-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist