Individual
MRS. AMY SUE MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW SAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
13279
WI
1041C0700X
Clinical Social Worker
Primary
1239-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42194800
—
WI
Enumeration date
09/06/2006
Last updated
02/28/2008
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