Mackenzie Forman, CCC-SLP
NPI 1679821490ActiveIndividual· Speech-Language Pathologist· Wake Forest, NC
Speech-Language Pathologist (CCC-SLP) with Legacy Healthcare Services Inc, practicing in Wake Forest, North Carolina. Enrolled in Medicare as practitioner - qualified speech language pathologist.
Overview
| NPI | 1679821490 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | CCC-SLP |
| Sole proprietor | Yes |
| NPI issued | Aug 28, 2012 |
| Last updated in NPPES | Mar 25, 2026 |
| Certified by provider | Mar 25, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Speech-Language Pathologist Primary | 235Z00000X | 9405 | NC |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Qualified Speech Language Pathologist (NC) |
|---|
Education and affiliations
| Graduation year | 2010 |
|---|---|
| Medicare specialty | Qualified Speech Language Pathologist |
Medical group
- Legacy Healthcare Services IncGreenville, SC · 3,223 clinicians
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