Provider Demographics
NPI:1033308549
Name:MACKEY, GENELLE JO (MSW)
Entity Type:Individual
Prefix:
First Name:GENELLE
Middle Name:JO
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-8659
Mailing Address - Country:US
Mailing Address - Phone:541-889-6123
Mailing Address - Fax:541-889-6123
Practice Address - Street 1:685 N OREGON ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1724
Practice Address - Country:US
Practice Address - Phone:541-889-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-275171041C0700X
ORL38861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical