Provider Demographics
NPI:1699375220
Name:MORGAN, MACKENZIE ASHLEY
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:ASHLEY
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:ASHLEY
Other - Last Name:STULKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:312 BISSET ST
Mailing Address - Street 2:
Mailing Address - City:YALE
Mailing Address - State:SD
Mailing Address - Zip Code:57386-2109
Mailing Address - Country:US
Mailing Address - Phone:605-353-5656
Mailing Address - Fax:
Practice Address - Street 1:357 KANSAS AVE SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2517
Practice Address - Country:US
Practice Address - Phone:605-352-8596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
SD66141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No374J00000XNursing Service Related ProvidersDoula