Healthcare Provider Details

I. General information

NPI: 1992694137
Provider Name (Legal Business Name): MAKENZIE GARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14315 108TH AVE STE 230
ORLAND PARK IL
60467-5701
US

IV. Provider business mailing address

9500 BORMET DR STE 304
MOKENA IL
60448-8399
US

V. Phone/Fax

Practice location:
  • Phone: 717-547-1503
  • Fax:
Mailing address:
  • Phone: 708-603-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number152.003575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: