Healthcare Provider Details

I. General information

NPI: 1518546175
Provider Name (Legal Business Name): ZACHARY ZIPPERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8445 MUNSON RD
MENTOR OH
44060-2410
US

IV. Provider business mailing address

8445 MUNSON RD
MENTOR OH
44060-2410
US

V. Phone/Fax

Practice location:
  • Phone: 440-255-1700
  • Fax: 440-205-2417
Mailing address:
  • Phone: 440-255-1700
  • Fax: 440-205-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: