Healthcare Provider Details

I. General information

NPI: 1659253680
Provider Name (Legal Business Name): MICHELLE ZUCKERMAN ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/26/2025
Certification Date: 07/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 N 15TH ST
COEUR D ALENE ID
83815-6496
US

IV. Provider business mailing address

2607 N ALTAMONT ST
SPOKANE WA
99207-5617
US

V. Phone/Fax

Practice location:
  • Phone: 412-500-4741
  • Fax:
Mailing address:
  • Phone: 412-500-4741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: