Healthcare Provider Details

I. General information

NPI: 1235165879
Provider Name (Legal Business Name): BRIAN JAMES ZINNBAUER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LANDMARK DR SUITE 300
BELLEVUE KY
41073-1393
US

IV. Provider business mailing address

3200 VINE ST
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 859-392-3852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5635
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: