Healthcare Provider Details

I. General information

NPI: 1477037711
Provider Name (Legal Business Name): LEAH MARIE ZOOK MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2018
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E SUPERIOR ST STE 415
DULUTH MN
55802-2007
US

IV. Provider business mailing address

11 E SUPERIOR ST STE 415
DULUTH MN
55802-2007
US

V. Phone/Fax

Practice location:
  • Phone: 218-393-5407
  • Fax: 218-730-2367
Mailing address:
  • Phone: 218-393-5407
  • Fax: 218-730-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22634
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: