Healthcare Provider Details

I. General information

NPI: 1851851604
Provider Name (Legal Business Name): KENNA MACKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 8TH ST
SPRINGFIELD OR
97477-4772
US

IV. Provider business mailing address

2094 FOUR OAKS GRANGE RD
EUGENE OR
97405-1013
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-4343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number25440
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: