Healthcare Provider Details

I. General information

NPI: 1427736495
Provider Name (Legal Business Name): MAKENZIE ADDIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 TOWER RD
DENVER CO
80249-7381
US

IV. Provider business mailing address

5496 E 120TH PL
THORNTON CO
80241-3287
US

V. Phone/Fax

Practice location:
  • Phone: 720-896-8832
  • Fax:
Mailing address:
  • Phone: 918-269-6953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: