Healthcare Provider Details

I. General information

NPI: 1972658995
Provider Name (Legal Business Name): JOHN SHERMAN MCKENZIE PSY.D., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 19TH ST NW SUITE #1
ROCHESTER MN
55901-6786
US

IV. Provider business mailing address

904 PLYMOUTH LN NW
ROCHESTER MN
55901-3447
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-7625
  • Fax: 507-529-7625
Mailing address:
  • Phone: 507-529-7625
  • Fax: 507-529-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP4456
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: