Mackenzie Clemons
Individual provider Active NPI Behavior Technician · Saint Clair, MI
NPI 1104665389 · NPPES record last updated May 20, 2024
Key facts
- NPI
- 1104665389
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 1159 S Carney Dr
Saint Clair, MI 48079-5569 - Phone
- (810) 328-3203
- NPI assigned
- May 20, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
1159 S Carney Dr
Saint Clair, MI 48079-5569
Mailing address
2521 N Elms Rd
Flushing, MI 48433-9423
Phone (866) 498-3909
Other providers in Saint Clair, MI
- Kimberly A Campolong
- Jamiella Jan Capps
- Katie Ann Chenault
- Alison Child
- Mikaela Michele Clarke
- Compassion Therapy Services LLC
- Debra Charles Cone
- Nicole Conigliaro
- Noelle Kathryn Cotter
- Mandy Marie Dalrymple
All providers in Saint Clair, MI · Behavior Technician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.