Healthcare Provider Details

I. General information

NPI: 1700907904
Provider Name (Legal Business Name): ANNEMARIE ZANCA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/17/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CLUB RD STE 350
EUGENE OR
97401-2599
US

IV. Provider business mailing address

5441 S MACADAM AVE STE R
PORTLAND OR
97239-6106
US

V. Phone/Fax

Practice location:
  • Phone: 541-343-1728
  • Fax: 855-282-3544
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC7228
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 2443
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier91256267
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: