Healthcare Provider Details

I. General information

NPI: 1124322490
Provider Name (Legal Business Name): SALVATORE E ZIZ MSSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 PURDUE AVE NE
SEATTLE WA
98105-2142
US

IV. Provider business mailing address

4550 PURDUE AVE NE
SEATTLE WA
98105-2142
US

V. Phone/Fax

Practice location:
  • Phone: 206-529-1164
  • Fax:
Mailing address:
  • Phone: 206-529-1164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 00004940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: