Healthcare Provider Details

I. General information

NPI: 1881505790
Provider Name (Legal Business Name): ZAC T THOMSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4640 B DR S
BATTLE CREEK MI
49015-9316
US

IV. Provider business mailing address

2679 FAIRWAY DR
JACKSON MI
49201-9315
US

V. Phone/Fax

Practice location:
  • Phone: 269-441-6550
  • Fax:
Mailing address:
  • Phone: 517-750-4473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6801089729
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: