Healthcare Provider Details

I. General information

NPI: 1831094002
Provider Name (Legal Business Name): LOUISE MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1350 PRAIRIE PKWY SW
WYOMING MI
49509-2743
US

IV. Provider business mailing address

1350 PRAIRIE PKWY SW
WYOMING MI
49509-2743
US

V. Phone/Fax

Practice location:
  • Phone: 616-530-7580
  • Fax:
Mailing address:
  • Phone: 616-530-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851107309
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: