Provider Demographics
NPI:1649759366
Name:HADDOX, MACKENZIE K
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:K
Last Name:HADDOX
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 1:12 SOUTHWINDS CIR APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4546
Mailing Address - Country:US
Mailing Address - Phone:636-221-0136
Mailing Address - Fax:
Practice Address - Street 1:11960 WESTLINE INDUSTRIAL DR STE 232
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3209
Practice Address - Country:US
Practice Address - Phone:314-579-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator