Healthcare Provider Details

I. General information

NPI: 1609437292
Provider Name (Legal Business Name): HEATHER ZOGLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7570 W 21ST ST N STE 1006C
WICHITA KS
67205-1773
US

IV. Provider business mailing address

1219 N PRESCOTT ST
WICHITA KS
67212-6851
US

V. Phone/Fax

Practice location:
  • Phone: 316-201-6445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3424
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: