Provider Demographics
NPI:1841777471
Name:WOLFE, MAKENZIE R (LCSW)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:R
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:R
Other - Last Name:SCOGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4294
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5100
Practice Address - Street 1:1300 E BRADFORD PKWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-4294
Practice Address - Country:US
Practice Address - Phone:417-761-5000
Practice Address - Fax:417-761-5100
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8900-M104100000X
MO20220316951041C0700X
AR8900-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker