Individual
MACKENZIE FORTNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDPT
Contact information
Practice address
1601 E 4TH PLAIN BLVD BLDG 17, VANCOUVER, WA 98661-3717
(360) 903-7998
Mailing address
600 SE 121ST AVE APT 162, VANCOUVER, WA 98683-6094
(360) 953-3165
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDPT.CO.70105850
WA
175T00000X
Peer Specialist
—
—
376K00000X
Nurse's Aide
NC61159336
WA
Other
Enumeration date
07/08/2022
Last updated
04/07/2026
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