Provider Demographics
NPI:1649627092
Name:CODY-BERRY, MAKINZIE ANN (LICSW)
Entity type:Individual
Prefix:
First Name:MAKINZIE
Middle Name:ANN
Last Name:CODY-BERRY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 RAINIER AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-1912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:206-325-6516
Practice Address - Street 1:635 ANDOVER PARK W STE 210
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3364
Practice Address - Country:US
Practice Address - Phone:206-678-7064
Practice Address - Fax:206-325-6516
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 101YM0800X
WA610413881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health