Individual
EVAN MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
399 E MAIN ST, COLUMBUS, OH 43215-5384
(614) 355-8000
Mailing address
DEPT 781625, DETROIT, MI 48278-1625
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1801965
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1473276
—
OH
Enumeration date
03/19/2020
Last updated
03/19/2020
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