Provider Demographics
NPI:1578311056
Name:BOOZIKEE, KENZIE
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:
Last Name:BOOZIKEE
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 1:10805 173RD ST W APT 127
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5338
Mailing Address - Country:US
Mailing Address - Phone:952-446-5082
Mailing Address - Fax:
Practice Address - Street 1:17685 JUNIPER PATH STE 303
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9821
Practice Address - Country:US
Practice Address - Phone:952-214-8959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional