MEDICARE: MCKENZIE WILSON

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1326928821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE WILSON

Provider Business Mailing Address
First Line	:	4341 S WESTNEDGE AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-3289
Country	:	US
Telephone Number	:	269-823-2675
Fax Number	:

Provider Business Practice Location Address
First Line	:	4341 S WESTNEDGE AVE STE AND1203
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-3289
Country	:	US
Telephone Number	:	269-823-2675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2025
Last Update Date	:	06/05/2026

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Directions to “ MCKENZIE WILSON ” Practice Location

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