Provider Demographics
NPI:1508356320
Name:BOWERS, MACKENZIE JUANITA
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JUANITA
Last Name:BOWERS
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 1:12530 109TH CT NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9139
Mailing Address - Country:US
Mailing Address - Phone:360-829-7848
Mailing Address - Fax:
Practice Address - Street 1:1820 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2094
Practice Address - Country:US
Practice Address - Phone:205-961-4726
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AL1-22-62520103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst