Provider Demographics
NPI:1942382841
Name:MCKENZIE, JACQUELINE (MASM, LSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MASM, LSW
Other - Prefix:MS
Other - First Name:J.
Other - Middle Name:
Other - Last Name:MCKENZIE'S PROFESSIONAL CONSULTANTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICDC, ICDC
Mailing Address - Street 1:4455 BROADBUSH DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1905
Mailing Address - Country:US
Mailing Address - Phone:937-251-7444
Mailing Address - Fax:937-715-4407
Practice Address - Street 1:24 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3831
Practice Address - Country:US
Practice Address - Phone:937-814-3573
Practice Address - Fax:937-715-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHS.00144441041C0700X
OH.943876101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical