Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mackenzie Forman, CCC-SLP

Individual provider Speech-Language Pathologist · NPI 1679821490

Mackenzie Forman, CCC-SLP is a Qualified Speech Language Pathologist in Wake Forest, North Carolina. Qualified in 2010, 16 years ago. Practices with Legacy Healthcare Services Inc, a 3,624-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
16
Licensed in
NC
In the registry since
2012
What do these letters mean?
CCC-SLP — Certificate of Clinical Competence in Speech-Language Pathology
A speech-language pathologist certified by ASHA.

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Practice location Address checks out

1151 S Main St Apt 303
Wake Forest, NC 27587-9660
Phone: (919) 556-1336
Fax: (919) 500-7696
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 9405 (NC)

Record details

NPI number1679821490
Entity typeIndividual (Type 1)
GenderFemale
Credentials CCC-SLP
Sole proprietorYes
NPI enumeratedAugust 28, 2012
Last updated in NPPESMarch 25, 2026
Certification dateMarch 25, 2026
Mailing address5326 Glenmorgan Ln, Raleigh, NC 27616-8884

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyQUALIFIED SPEECH LANGUAGE PATHOLOGIST
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Legacy Healthcare Services Inc — 3624 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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