Healthcare Provider Details

I. General information

NPI: 1427767995
Provider Name (Legal Business Name): MACKENZIE SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 N WASHINGTON ST STE GG
BISMARCK ND
58501-1669
US

IV. Provider business mailing address

2200 20TH ST SW
JAMESTOWN ND
58401-7500
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-2315
  • Fax:
Mailing address:
  • Phone: 701-252-3850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-342650
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: