Healthcare Provider Details

I. General information

NPI: 1437656667
Provider Name (Legal Business Name): ANNA MAE ZUIDEMA MA, NCC, TLMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 BUCKEYE AVE STE 104
AMES IA
50010-8120
US

IV. Provider business mailing address

308 VAN BUREN DR
VAN METER IA
50261-9742
US

V. Phone/Fax

Practice location:
  • Phone: 515-337-1380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number090494
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: