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NPI Code Detail

MEDICARE: JOSEPH MCKENZIE SAC-IT

MEDICARE: JOSEPH MCKENZIE SAC-IT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor19364WI

General Provider Information

NPI Number : 1316520182
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH MCKENZIE SAC-IT
Provider Business Mailing Address
First Line : 255 W BROADWAY
Second Line :
City : WAUKESHA
State : WI
Zip : 53186-4832
Country : US
Telephone Number : 262-420-9088
Fax Number :
Provider Business Practice Location Address
First Line : 255 W BROADWAY
Second Line :
City : WAUKESHA
State : WI
Zip : 53186-4832
Country : US
Telephone Number : 262-420-9088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2021
Last Update Date : 04/29/2021

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