Healthcare Provider Details

I. General information

NPI: 1407067200
Provider Name (Legal Business Name): MICHAEL ZUCKERMANN M.A. R.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVE SUITE # 2001
SEATTLE WA
98101-3123
US

IV. Provider business mailing address

1200 6TH AVE SUITE # 2001
SEATTLE WA
98101-3123
US

V. Phone/Fax

Practice location:
  • Phone: 425-369-9172
  • Fax:
Mailing address:
  • Phone: 425-369-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberRC00019706
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: