Individual
MACKENZIE THIELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
936 ROSCOE ST, GREEN BAY, WI 54304-3464
(775) 530-4580
Mailing address
936 ROSCOE ST, GREEN BAY, WI 54304-3464
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
135143-121
WI
Other
Enumeration date
10/23/2025
Last updated
10/23/2025
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