Provider Demographics
NPI:1912426677
Name:MACKENZIE, HEATHER (LICSW, LCSW CADC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:LICSW, LCSW CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 W GUNNISON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6575
Mailing Address - Country:US
Mailing Address - Phone:312-593-3012
Mailing Address - Fax:
Practice Address - Street 1:2459 W GUNNISON ST APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-6575
Practice Address - Country:US
Practice Address - Phone:312-593-3012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22301041C0700X
1041C0700X
IL26605101YA0400X
TN74991041C0700X
IL149.0183001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)