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NPI Code Detail

MEDICARE: MACKENZIE AMANI ISAAX

MEDICARE: MACKENZIE AMANI ISAAX
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
1106S00000XBehavior TechnicianRBT-25-504048IL

General Provider Information

NPI Number : 1881540946
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE AMANI ISAAX
Provider Business Mailing Address
First Line : 710 WHITE OAK DR APT 4
Second Line :
City : O FALLON
State : IL
Zip : 62269-7320
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 411 EDWARDSVILLE RD
Second Line :
City : TROY
State : IL
Zip : 62294-1339
Country : US
Telephone Number : 314-275-0506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2026
Last Update Date : 03/10/2026

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Directions to “ MACKENZIE AMANI ISAAX ” Practice Location

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