Healthcare Provider Details

I. General information

NPI: 1033085170
Provider Name (Legal Business Name): MACKENZIE JOY BEKEDAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 09/30/2026
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22018 S CENTRAL POINT RD
CANBY OR
97013-8705
US

IV. Provider business mailing address

3200 NE 109THE AVENUE
VANCOUVER WA
98682
US

V. Phone/Fax

Practice location:
  • Phone: 503-221-4531
  • Fax:
Mailing address:
  • Phone: 360-695-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSC70151111
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: