Healthcare Provider Details

I. General information

NPI: 1760283485
Provider Name (Legal Business Name): MACKENZIE MARIE HUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 BOONE AIRE RD
FLORENCE KY
41042-1202
US

IV. Provider business mailing address

520 OVERTON ST APT 1N
NEWPORT KY
41071-4641
US

V. Phone/Fax

Practice location:
  • Phone: 859-282-6518
  • Fax:
Mailing address:
  • Phone: 859-653-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB1262116
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: