Provider Demographics
NPI:1073274866
Name:MCKENZIE, REBECCA DAWN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DAWN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:AINSLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5240 NE ELAM YOUNG PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6438
Mailing Address - Country:US
Mailing Address - Phone:503-846-3350
Mailing Address - Fax:
Practice Address - Street 1:5240 NE ELAM YOUNG PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-6438
Practice Address - Country:US
Practice Address - Phone:503-846-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist