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General NPI Number Information
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NPI Number | 1972118008
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Entity Type | Individual
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Provider Name | MACKENZIE LEE WESTERMEYER LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 28 2ND ST NW
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City | ORTONVILLE
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State | MN
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Zip | 56278-1407
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Country | US
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Telephone | 320-839-8322
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Fax | 855-867-8780
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Provider Business Mailing Address
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Address Line | 627 OTTO AVE
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City | ORTONVILLE
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State | MN
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Zip | 56278-1168
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Country | US
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Telephone | 320-305-0645
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 23014
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License Number State | MN
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