Provider Demographics
NPI:1962232421
Name:SHINK, MAKENZIE ANNE
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:ANNE
Last Name:SHINK
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 1:4552 SPAHR ST
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-1122
Mailing Address - Country:US
Mailing Address - Phone:248-890-9272
Mailing Address - Fax:
Practice Address - Street 1:4552 SPAHR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1122
Practice Address - Country:US
Practice Address - Phone:248-890-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician