Provider Demographics
NPI:1407698467
Name:STRAZANAC, MAKENZIE KAY (LLP)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:KAY
Last Name:STRAZANAC
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15906 WINANS ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9636
Mailing Address - Country:US
Mailing Address - Phone:616-607-4836
Mailing Address - Fax:
Practice Address - Street 1:1475 ROBBINS RD STE 150
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-3700
Practice Address - Country:US
Practice Address - Phone:616-315-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009931103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical