Provider Demographics
NPI:1972118008
Name:WESTERMEYER, MACKENZIE LEE (LICSW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEE
Last Name:WESTERMEYER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 OTTO AVE
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56278-1168
Mailing Address - Country:US
Mailing Address - Phone:320-305-0645
Mailing Address - Fax:
Practice Address - Street 1:28 2ND ST NW
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MN
Practice Address - Zip Code:56278-1407
Practice Address - Country:US
Practice Address - Phone:320-839-8322
Practice Address - Fax:855-867-8780
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN230141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical