Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mackenzie Bullerjahn, LCSW

Individual provider Clinical Social Worker · NPI 1528852464

Mackenzie Bullerjahn, LCSW is a Clinical Social Worker in Grand Forks, North Dakota. Qualified in 2017, 9 years ago. Practices with Peterson Medical Clinics LLC, a 89-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New Jersey.

Years since qualifying
9
Licensed in
NJ
In the registry since
2025
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

3674 S Washington St
Grand Forks, ND 58201-5766
Phone: (701) 732-2538
Fax: (701) 732-2501
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 44SC06185700 (NJ)

Record details

NPI number1528852464
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedApril 7, 2025
Last updated in NPPESJanuary 22, 2026
Certification dateJanuary 22, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Peterson Medical Clinics Llc — 89 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

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