Provider Demographics
NPI:1275295222
Name:BENNETT, MACKENZIE TAYLOR
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:TAYLOR
Last Name:BENNETT
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:PO BOX 3103
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43702-3103
Mailing Address - Country:US
Mailing Address - Phone:740-319-4533
Mailing Address - Fax:
Practice Address - Street 1:58 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3527
Practice Address - Country:US
Practice Address - Phone:740-214-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker