Healthcare Provider Details

I. General information

NPI: 1336863083
Provider Name (Legal Business Name): ZACKARIAH HART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8444 RAINIER AVE S
SEATTLE WA
98118-4655
US

IV. Provider business mailing address

325 W GOWE ST
KENT WA
98032-5892
US

V. Phone/Fax

Practice location:
  • Phone: 253-833-7444
  • Fax:
Mailing address:
  • Phone: 253-833-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLW.70014332
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: