Individual
MACKENZIE DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APSW
Contact information
Practice address
2108 63RD ST, KENOSHA, WI 53143-4454
(262) 652-2406
Mailing address
2108 63RD ST, KENOSHA, WI 53143-4454
(262) 652-2406
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
132108
WI
Other
Enumeration date
10/19/2020
Last updated
10/19/2020
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