MEDICARE: MAKENNA HECKSEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1104798602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENNA HECKSEL

Provider Business Mailing Address
First Line	:	17065 COUNTY ROAD 20
Second Line	:
City	:	MAYER
State	:	MN
Zip	:	55360-8600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 CHESHIRE LN N STE 1
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55446-3863
Country	:	US
Telephone Number	:	612-439-4650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	09/24/2025

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Directions to “ MAKENNA HECKSEL ” Practice Location

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