Provider Demographics
NPI:1619508470
Name:CRITZER, MAKENZEE DENAE
Entity type:Individual
Prefix:
First Name:MAKENZEE
Middle Name:DENAE
Last Name:CRITZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAKENZEE
Other - Middle Name:DENAE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5072 E COPPER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-7703
Mailing Address - Country:US
Mailing Address - Phone:559-349-2228
Mailing Address - Fax:
Practice Address - Street 1:7120 N MARKS AVE STE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0268
Practice Address - Country:US
Practice Address - Phone:559-439-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician