Healthcare Provider Details

I. General information

NPI: 1033744511
Provider Name (Legal Business Name): ROBERT MICAL ZIEMAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROB MICAL ZIEMAK

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31517 120TH CT SE
AUBURN WA
98092-5102
US

IV. Provider business mailing address

31517 120TH CT SE
AUBURN WA
98092-5102
US

V. Phone/Fax

Practice location:
  • Phone: 206-353-4995
  • Fax:
Mailing address:
  • Phone: 206-353-4995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: