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General NPI Number Information
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NPI Number | 1992344824
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Entity Type | Individual
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Provider Name | ANISA M MCKENZIE
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Gender | Female
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Dates
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Enumeration Date | 12/23/2019
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Last Update Date | 06/22/2022
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Provider Practice Location Address
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Address Line | 548 SE JACKSON ST
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City | ROSEBURG
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State | OR
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Zip | 97470-4983
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Country | US
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Telephone | 541-530-6777
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Fax |
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Provider Business Mailing Address
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Address Line | 11 BRINLEY ST APT 2
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City | NEWPORT
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State | RI
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Zip | 02840-3238
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Country | US
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Telephone | 401-207-6974
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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