Provider Demographics
NPI:1467031369
Name:TEFFT, MACKENZIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:TEFFT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 W THOMAS ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3482
Mailing Address - Country:US
Mailing Address - Phone:651-238-0140
Mailing Address - Fax:
Practice Address - Street 1:405 N WABASH AVE UNIT 1114
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3597
Practice Address - Country:US
Practice Address - Phone:651-238-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0230401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical