Provider Demographics
NPI:1326328105
Name:MANN, MADISON MCKENZIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:MCKENZIE
Last Name:MANN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:MADISON
Other - Middle Name:MCKENZIE
Other - Last Name:CHESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:4118 BULLARD AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:ELMENDORF AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99506-1420
Mailing Address - Country:US
Mailing Address - Phone:229-251-3798
Mailing Address - Fax:
Practice Address - Street 1:4020 FOLKER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5321
Practice Address - Country:US
Practice Address - Phone:907-563-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor