Healthcare Provider Details

I. General information

NPI: 1780336628
Provider Name (Legal Business Name): VIRGINIA B BACCELLIA-ZIEGLER MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 FORTUYN RD
GRAND COULEE WA
99133
US

IV. Provider business mailing address

840 E PLUM ST
MOSES LAKE WA
98837-1874
US

V. Phone/Fax

Practice location:
  • Phone: 509-633-1471
  • Fax:
Mailing address:
  • Phone: 509-765-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: