Provider Demographics
NPI:1336895291
Name:MACKE, KRISTEN ROBEY
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ROBEY
Last Name:MACKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9370 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1057
Mailing Address - Country:US
Mailing Address - Phone:985-788-7829
Mailing Address - Fax:
Practice Address - Street 1:9370 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1057
Practice Address - Country:US
Practice Address - Phone:985-788-7829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst