Provider Demographics
NPI:1700779691
Name:CAVANAUGH, MAKENZI (ND)
Entity type:Individual
Prefix:
First Name:MAKENZI
Middle Name:
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:MAKENZI
Other - Middle Name:
Other - Last Name:CAVANAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:13404 NEWCASTLE COMMONS DR APT 217
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3211
Mailing Address - Country:US
Mailing Address - Phone:330-703-6776
Mailing Address - Fax:
Practice Address - Street 1:12600 SE 38TH ST STE 130
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-6105
Practice Address - Country:US
Practice Address - Phone:425-679-6056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT61646670175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath