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NPI Code Detail

MEDICARE: MACKENZIE RICE

MEDICARE:   MACKENZIE  RICE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1083082077
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE RICE
Provider Business Mailing Address
First Line : 1555 SW 35TH ST
Second Line :
City : CORVALLIS
State : OR
Zip : 97333-1130
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6444 FAIRWAY AVE SE
Second Line :
City : SALEM
State : OR
Zip : 97306-3073
Country : US
Telephone Number : 971-901-2731
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2015
Last Update Date : 06/25/2024

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Directions to “ MACKENZIE RICE ” Practice Location

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