Healthcare Provider Details

I. General information

NPI: 1023788015
Provider Name (Legal Business Name): TAYLOR MCKENZIE ARCHIBALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR MCKENZIE WASHE

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 KEEWAHDIN RD
FORT GRATIOT MI
48059-3498
US

IV. Provider business mailing address

5039 VILLA LINDE PKWY STE 30
FLINT MI
48532-3450
US

V. Phone/Fax

Practice location:
  • Phone: 910-837-2345
  • Fax:
Mailing address:
  • Phone: 989-401-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: