Healthcare Provider Details

I. General information

NPI: 1679837561
Provider Name (Legal Business Name): JOAN M ZANDER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 42ND ST WEST
WILLISTON ND
58801
US

IV. Provider business mailing address

6301 19TH AVE NW
MINOT ND
58703-8899
US

V. Phone/Fax

Practice location:
  • Phone: 701-509-3850
  • Fax:
Mailing address:
  • Phone: 701-858-0115
  • Fax: 701-852-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4064
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: