Provider Demographics
NPI:1013468065
Name:CLEGG, MACKENZIE ERIN
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ERIN
Last Name:CLEGG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:ERIN
Other - Last Name:SAVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14166 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:MARNE
Mailing Address - State:MI
Mailing Address - Zip Code:49435-9759
Mailing Address - Country:US
Mailing Address - Phone:248-805-2643
Mailing Address - Fax:
Practice Address - Street 1:790 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1918
Practice Address - Country:US
Practice Address - Phone:616-336-3909
Practice Address - Fax:616-336-8830
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other