Provider Demographics
NPI:1518642784
Name:BLUNT, MCKENZIE JESSEN
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:JESSEN
Last Name:BLUNT
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 1:16920 24TH PL NE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-9645
Mailing Address - Country:US
Mailing Address - Phone:650-863-2452
Mailing Address - Fax:
Practice Address - Street 1:16920 24TH PL NE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-9645
Practice Address - Country:US
Practice Address - Phone:650-863-2452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician