Healthcare Provider Details

I. General information

NPI: 1497629414
Provider Name (Legal Business Name): XYZLEENA B ZIPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S FIFE ST STE 301
TACOMA WA
98409-7309
US

IV. Provider business mailing address

6418 DELPHI RD SW
OLYMPIA WA
98512-2060
US

V. Phone/Fax

Practice location:
  • Phone: 253-412-0960
  • Fax:
Mailing address:
  • Phone: 360-292-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: