Healthcare Provider Details

I. General information

NPI: 1164304432
Provider Name (Legal Business Name): LISA JUNE ZOLLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 FAWCETT AVE
TACOMA WA
98402-5503
US

IV. Provider business mailing address

737 FAWCETT AVE
TACOMA WA
98402-5503
US

V. Phone/Fax

Practice location:
  • Phone: 253-396-5800
  • Fax:
Mailing address:
  • Phone: 253-396-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAAR.CG.70031866
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: