MEDICARE: MAKENNA SMALLWOOD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1790620573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKENNA SMALLWOOD

Provider Business Mailing Address
First Line	:	6963 GOSHEN RD
Second Line	:
City	:	GOSHEN
State	:	OH
Zip	:	45122-9742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8809B CINCINNATI DAYTON RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3134
Country	:	US
Telephone Number	:	513-360-8205
Fax Number	:

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

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ MAKENNA SMALLWOOD ” Practice Location

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