MEDICARE: MACKENZIE LYNN UHLENHOPP

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	225A00000X	Music Therapist

General Provider Information

NPI Number	:	1821566910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE LYNN UHLENHOPP

Provider Business Mailing Address
First Line	:	2561 ALABAMA AVE S
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-1760
Country	:	US
Telephone Number	:	319-939-3474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2561 ALABAMA AVE S
Second Line	:
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-1760
Country	:	US
Telephone Number	:	319-939-3474
Fax Number	:

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

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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