Provider Demographics
NPI:1972658995
Name:MCKENZIE, JOHN SHERMAN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SHERMAN
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 PLYMOUTH LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3447
Mailing Address - Country:US
Mailing Address - Phone:507-529-7625
Mailing Address - Fax:507-529-7625
Practice Address - Street 1:3253 19TH ST NW
Practice Address - Street 2:SUITE #1
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6786
Practice Address - Country:US
Practice Address - Phone:507-529-7625
Practice Address - Fax:507-529-7625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4456103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling