1942382841 NPI number — MS. JACQUELINE MCKENZIE M.A.S.M., L.S.W.

Table of content: MS. JACQUELINE MCKENZIE M.A.S.M., L.S.W. (NPI 1942382841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942382841 NPI number — MS. JACQUELINE MCKENZIE M.A.S.M., L.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKENZIE
Provider First Name:
JACQUELINE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.S.M., L.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCKENZIE'S PROFESSIONAL CONSULTANTS
Provider Other First Name:
J.
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.I.C.D.C., I.C.D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1942382841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4455 BROADBUSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROTWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45426-1905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-251-7444
Provider Business Mailing Address Fax Number:
937-715-4407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 GLENWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45405-3831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-814-3573
Provider Business Practice Location Address Fax Number:
937-715-4407
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: S.0014444 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: .943876 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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