Healthcare Provider Details

I. General information

NPI: 1649013590
Provider Name (Legal Business Name): KELLY ZINK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY WOZNICK

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date: 08/11/2026
Reactivation Date: 08/24/2026

III. Provider practice location address

1165 AIRPORT BLVD
AUSTIN TX
78702-3152
US

IV. Provider business mailing address

1165 AIRPORT BLVD
AUSTIN TX
78702-3152
US

V. Phone/Fax

Practice location:
  • Phone: 512-472-4357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17898
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: