Provider Demographics
NPI:1639503022
Name:ENCE, MCKENNA MARIE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:MCKENNA
Middle Name:MARIE
Last Name:ENCE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1230
Mailing Address - Country:US
Mailing Address - Phone:248-646-3347
Mailing Address - Fax:
Practice Address - Street 1:919 MILESTONE DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-2552
Practice Address - Country:US
Practice Address - Phone:435-563-8618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist