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NPI Code Detail

MEDICARE: MAKENZIE GROVE CT

MEDICARE: MAKENZIE GROVE CT
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
1390200000XStudent in an Organized Health Care Education/Training ProgramC.2507356-TRNEOH

General Provider Information

NPI Number : 1578407144
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKENZIE GROVE CT
Provider Business Mailing Address
First Line : 1925 HAYES AVE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4737
Country : US
Telephone Number : 419-557-5177
Fax Number :
Provider Business Practice Location Address
First Line : 1925 HAYES AVE
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4737
Country : US
Telephone Number : 419-557-5184
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2026
Last Update Date : 04/15/2026

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1972758878 — MR. JEREMY MICHAEL CHERRY MFT, PC
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Directions to “ MAKENZIE GROVE CT” Practice Location

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