Healthcare Provider Details

I. General information

NPI: 1053185322
Provider Name (Legal Business Name): JESSICA ZAVALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 N WOODLAWN ST STE 400
WICHITA KS
67208-1875
US

IV. Provider business mailing address

2112 N WELLINGTON PL
WICHITA KS
67203-2434
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-9600
  • Fax:
Mailing address:
  • Phone: 956-240-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: