Provider Demographics
NPI:1316717861
Name:RICH, MACKENZIE (CHW)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 L ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3491
Mailing Address - Country:US
Mailing Address - Phone:541-460-8622
Mailing Address - Fax:
Practice Address - Street 1:1200 HILYARD ST STE 430
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8161
Practice Address - Country:US
Practice Address - Phone:458-205-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000109818172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker