Provider Demographics
NPI:1033971882
Name:MCDONALD, MACKENZIE N
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:N
Last Name:MCDONALD
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 1:22021 7TH AVE S STE 205
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6218
Mailing Address - Country:US
Mailing Address - Phone:425-246-7038
Mailing Address - Fax:
Practice Address - Street 1:22021 7TH AVE S STE 205
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6218
Practice Address - Country:US
Practice Address - Phone:425-246-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician