Healthcare Provider Details

I. General information

NPI: 1245839356
Provider Name (Legal Business Name): MAKENZIE KOJIS MT-BC, WMTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W NATIONAL AVE
MILWAUKEE WI
53295-0001
US

IV. Provider business mailing address

21900 FOXHAVEN RUN APT 3
WAUKESHA WI
53186-1841
US

V. Phone/Fax

Practice location:
  • Phone: 414-384-2000
  • Fax:
Mailing address:
  • Phone: 262-492-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number111-038
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: