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NPI Code Detail

MEDICARE: MAKENZIE R WOLFE MSW, LCSW

MEDICARE: MAKENZIE R WOLFE MSW, LCSW
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
11041C0700XClinical Social Worker2022031695MO
21041C0700XClinical Social Worker8900-CAR

General Provider Information

NPI Number : 1841777471
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKENZIE R WOLFE MSW, LCSW
Provider Business Mailing Address
First Line : 1300 E BRADFORD PKWY
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-4294
Country : US
Telephone Number : 417-761-5000
Fax Number : 417-761-5100
Provider Business Practice Location Address
First Line : 1300 E BRADFORD PKWY
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65804-4294
Country : US
Telephone Number : 417-761-5000
Fax Number : 417-761-5100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2018
Last Update Date : 04/10/2025

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