Healthcare Provider Details

I. General information

NPI: 1659649796
Provider Name (Legal Business Name): SAVANNA NICOLE ZELINKA L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2011
Last Update Date: 12/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 NE HOGAN DR
GRESHAM OR
97030-4129
US

IV. Provider business mailing address

PO BOX 622
SANDY OR
97055-0622
US

V. Phone/Fax

Practice location:
  • Phone: 503-449-4129
  • Fax:
Mailing address:
  • Phone: 503-449-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18607
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: