MCKENZIE RAE MALLEN (NPI# 1417484973) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417484973 |
| Entity Type | Individual |
| Full Name | MCKENZIE RAE MALLEN |
| Practice Address |
1175 Cane Bay Blvd Summerville SC 29486-2396 |
| Practice Telephone | 8438991957 |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TS0200X |
Psychologist Specialization: School |
280059 | SC | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 101 Gearing St, Goose Creek, SC 294456249 | 8435723373 |
| Street Address |
1175 CANE BAY BLVD |
| City | SUMMERVILLE |
| State | SC |
| Zip Code | 29486-2396 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921454 | Cooper River Pediatric Therapy LLC | Speech-Language Pathologist | 119 Callibluff Dr, Summerville, SC 29486 | 2020-04-24 |
| 1750928164 | Tidewater Eyecare, LLC | Optometrist | 301 Front St., Summerville, SC 29486 | 2019-12-04 |
| 1366086621 | Tgd-summerville LLC | Dentist | 604-a Nexton Square Dr, Summerville, SC 29486 | 2019-10-30 |
| 1336783604 | Tdsp-summerville LLC | Dentist | 604-b Nexton Square Dr, Summerville, SC 29486 | 2019-10-30 |
| 1699256081 | Denise Michelle Richardson | Speech-Language Pathologist | 201 School House Ln, Summerville, SC 29486 | 2018-08-24 |
| 1497243588 | Charleston Ent Associates, LLC | Non-Pharmacy Dispensing Site | 2205 2nd Avenue, Summerville, SC 29486 | 2018-04-25 |
| 1043707557 | Seaside Family Medicine, LLC | Nurse Practitioner | 1341 College Park Rd # A, Summerville, SC 29486 | 2018-04-19 |
| 1023511144 | Grace Physical Therapy and Sports Rehab At Nexton | Clinic/Center | 5500 Front St, Suite 201, Summerville, SC 29486 | 2018-03-15 |
| 1295253086 | Dillon Robert Gregory | Specialist/Technologist | 313 Springdale Ct., Summerville, SC 29486 | 2017-09-01 |
| 1013456987 | Sfd Kids LLC | Dentist | 108 Parish Farms Drive, Summerville, SC 29486 | 2017-02-13 |
| Find all providers in zip 29486 | ||||
| Taxonomy Code | 103TS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407356439 | Lakia Charise Johnson | Psychologist | 230 Avonshire Dr, Summerville, SC 29483-7355 | 2018-02-16 |
| 1912422296 | Henry C Thompson II | Psychologist | 115 Devon Rd, Summerville, SC 29483-9346 | 2017-08-08 |
| 1649586025 | Lynn Snipes Wogamon | Psychologist | 1002 Crooked Oak Rd, Summerville, SC 29485-6225 | 2010-08-24 |
| 1790096436 | Andrew James Preston | Psychologist | 1815 Bacons Bridge Rd Apt B12, Summerville, SC 29485-3258 | 2010-06-28 |
| 1760906523 | Rachel Ellingson | Psychologist | 1624 State Rd, Summerville, SC 29486-2752 | 2017-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144842865 | Maria Fernanda Dasilva | Psychologist | 2032 Emerald Pines Dr, Tega Cay, SC 29708-8330 | 2020-05-15 |
| 1891338794 | Joe Babcock | Psychologist | 101 Sugarfield Ct, Greer, SC 29650-3353 | 2019-10-23 |
| 1851941314 | Seagrass Psychoeducational Solutions LLC | Psychologist | 10 Pinckney Colony Rd Ste 312, Bluffton, SC 29909-4148 | 2019-09-17 |
| 1699325225 | Catherine Anne Aurora Pinnola | Psychologist | 4012 Atalaya Pl, Myrtle Beach, SC 29579-5175 | 2019-09-16 |
| 1306400825 | Laurie Stroupe | Psychologist | 210 N Mcduffie St Ste 102, Anderson, SC 29621-5648 | 2019-04-30 |
| 1093270092 | Sarah Rasel | Psychologist | 262 Red Cedar St Ste 4, Bluffton, SC 29910-8968 | 2019-02-04 |
| 1649745845 | Brandi T Dennis | Psychologist | 2011 2nd Loop Rd Ste A, Florence, SC 29501-6187 | 2018-10-04 |
| 1285116152 | Joneen Mary Adams | Psychologist | 895 N Fraser St, Georgetown, SC 29440-3356 | 2018-09-06 |
| 1992284236 | Emma J Merry | Psychologist | 420 E Park Ave Ste 304, Greenville, SC 29601-2257 | 2018-08-08 |
| 1093208894 | Sophie Ellis | Psychologist | 9217 University Blvd Ste C1a, North Charleston, SC 29406-9147 | 2018-06-07 |
| Find all providers with the same taxonomy | ||||
| City | SUMMERVILLE |
| Zip Code | 29486 |
Please comment or provide details below to improve the information on MCKENZIE RAE MALLEN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.