Healthcare Provider Details

I. General information

NPI: 1881102978
Provider Name (Legal Business Name): HEATHER MARIE ZINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2018
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12650 E BRIARWOOD AVE
CENTENNIAL CO
80112-6792
US

IV. Provider business mailing address

390 UNION BLVD STE 300
LAKEWOOD CO
80228-6514
US

V. Phone/Fax

Practice location:
  • Phone: 720-334-5167
  • Fax:
Mailing address:
  • Phone: 303-989-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-41360
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: