Healthcare Provider Details

I. General information

NPI: 1295399731
Provider Name (Legal Business Name): ZARASUN POND MSW, CSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZARASUN KEYS MSW

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 NW HUGHWOOD CT
ROSEBURG OR
97471-8844
US

IV. Provider business mailing address

1652 NW HUGHWOOD CT
ROSEBURG OR
97471-8844
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-3985
  • Fax: 541-673-8060
Mailing address:
  • Phone: 541-673-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA5493
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: