Healthcare Provider Details

I. General information

NPI: 1760230668
Provider Name (Legal Business Name): MACKENZIE KATE MORRIS QMHA-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 N ELM ST
CANBY OR
97013-3519
US

IV. Provider business mailing address

113 N ELM ST
CANBY OR
97013-3519
US

V. Phone/Fax

Practice location:
  • Phone: 503-372-5147
  • Fax: 503-266-8632
Mailing address:
  • Phone: 503-372-5147
  • Fax: 503-266-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: