Provider Demographics
NPI:1760261069
Name:MORGAN, MAKENNA ALEECE (MSW, CSW)
Entity Type:Individual
Prefix:
First Name:MAKENNA
Middle Name:ALEECE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 S BLAZING OAK DR
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-2857
Mailing Address - Country:US
Mailing Address - Phone:385-285-2594
Mailing Address - Fax:
Practice Address - Street 1:11978 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7403
Practice Address - Country:US
Practice Address - Phone:385-285-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13602545-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker