Provider Demographics
NPI:1124673934
Name:SIENKIEWICH, MCKENZIE L
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:L
Last Name:SIENKIEWICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:L
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27421 30TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27421 30TH AVE E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387
Practice Address - Country:US
Practice Address - Phone:253-341-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2024-11-06
Deactivation Date:2024-10-09
Deactivation Code:
Reactivation Date:2024-11-06
Provider Licenses
StateLicense IDTaxonomies
WARBT-19-9158103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARBT-19-95198OtherRBT CERTIFICATION NUMBER