Individual
MS. MAKENNA LACEY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSWA
Contact information
Practice address
150 S WALL ST, COOS BAY, OR 97420-3233
(541) 435-7200
Mailing address
1139 CALIFORNIA AVE, COOS BAY, OR 97420-1111
(541) 525-5803
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
A12390
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500791438
—
OR
01
—
A12390
CLINICAL SOCIAL WORK ASSOCIATE
OR
Enumeration date
04/05/2021
Last updated
11/06/2025
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