Provider Demographics
NPI:1932662509
Name:ROBERTSON, MCKENZIE (CSW, LMSW)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 W CANYON CREST RD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004-1645
Mailing Address - Country:US
Mailing Address - Phone:801-999-8833
Mailing Address - Fax:801-373-0639
Practice Address - Street 1:165 W CANYON CREST RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1645
Practice Address - Country:US
Practice Address - Phone:801-999-8833
Practice Address - Fax:801-373-0639
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-188701041C0700X
UT11868675-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical