Healthcare Provider Details

I. General information

NPI: 1932401197
Provider Name (Legal Business Name): ROBIN R. ZOLLAR L,M,S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2010
Last Update Date: 11/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SHIP ST SUITE 204
SAINT JOSEPH MI
49085-1180
US

IV. Provider business mailing address

PO BOX 500
SAINT JOSEPH MI
49085-0500
US

V. Phone/Fax

Practice location:
  • Phone: 269-983-4242
  • Fax: 269-983-4242
Mailing address:
  • Phone: 269-983-4242
  • Fax: 269-983-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801017564
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: