Provider Demographics
NPI:1881420149
Name:ZERWAS, MAKENNA CHRISTINA
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:CHRISTINA
Last Name:ZERWAS
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 1:4225 TIMBERRIDGE LN APT D
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4104
Mailing Address - Country:US
Mailing Address - Phone:763-290-9011
Mailing Address - Fax:
Practice Address - Street 1:4140 RICHARD AVE UNIT 200&300
Practice Address - Street 2:
Practice Address - City:HERMANTOWN
Practice Address - State:MN
Practice Address - Zip Code:55811-2869
Practice Address - Country:US
Practice Address - Phone:218-520-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician