Provider Demographics
NPI:1275262750
Name:EGNER, MAKENSIE LEIGH I
Entity Type:Individual
Prefix:
First Name:MAKENSIE
Middle Name:LEIGH
Last Name:EGNER
Suffix:I
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 1:8355 SANTIAGO CIR
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-7113
Mailing Address - Country:US
Mailing Address - Phone:949-615-9216
Mailing Address - Fax:
Practice Address - Street 1:8355 SANTIAGO CIR
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-7113
Practice Address - Country:US
Practice Address - Phone:949-615-9216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty