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NPI Code Detail

MEDICARE: MAKENNA CHURCH

MEDICARE: MAKENNA CHURCH
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1962331223
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKENNA CHURCH
Provider Business Mailing Address
First Line : 5465 S IVA RD
Second Line :
City : SAINT CHARLES
State : MI
Zip : 48655-8738
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7110 MICHIGAN RD
Second Line :
City : BAY CITY
State : MI
Zip : 48706-9310
Country : US
Telephone Number : 989-757-7514
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2026
Last Update Date : 05/14/2026

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Directions to “ MAKENNA CHURCH ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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