Provider Demographics
NPI:1750180287
Name:BRANDON, MAKENNA GRACE
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:GRACE
Last Name:BRANDON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:MI
Mailing Address - Zip Code:49021-1418
Mailing Address - Country:US
Mailing Address - Phone:269-719-9850
Mailing Address - Fax:
Practice Address - Street 1:517 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:MI
Practice Address - Zip Code:49021-1418
Practice Address - Country:US
Practice Address - Phone:269-719-9850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty