Provider Demographics
NPI:1437992161
Name:MCKINNIE, MARQUESA ANIYA
Entity type:Individual
Prefix:
First Name:MARQUESA
Middle Name:ANIYA
Last Name:MCKINNIE
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 1:625 S BELLS ST
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-2100
Mailing Address - Country:US
Mailing Address - Phone:731-345-6403
Mailing Address - Fax:
Practice Address - Street 1:625 S BELLS ST
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-2100
Practice Address - Country:US
Practice Address - Phone:731-345-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist