Provider Demographics
NPI:1215404272
Name:HALL, MACKENZIE (SWT)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:SWT
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:LUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SWT
Mailing Address - Street 1:1925 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4737
Mailing Address - Country:US
Mailing Address - Phone:419-557-5177
Mailing Address - Fax:419-557-5179
Practice Address - Street 1:76 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1908
Practice Address - Country:US
Practice Address - Phone:419-448-9440
Practice Address - Fax:419-448-5155
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1700024-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker