Provider Demographics
NPI:1427897560
Name:O'CONNELL, MAKENZIE ELIZABETH
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:ELIZABETH
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 VICTORIA ST N
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-5852
Mailing Address - Country:US
Mailing Address - Phone:612-991-0813
Mailing Address - Fax:
Practice Address - Street 1:9120 SPRINGBROOK DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5845
Practice Address - Country:US
Practice Address - Phone:763-231-2590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician