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General NPI Number Information
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NPI Number | 1043134620
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Entity Type | Individual
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Provider Name | ZACHARY HEATON
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Gender | Male
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 357 W CENTER ST STE 3
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City | POCATELLO
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State | ID
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Zip | 83204-3236
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Country | US
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Telephone | 208-244-0081
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Fax | 833-307-2598
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Provider Business Mailing Address
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Address Line | 707 N ARTHUR AVE
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City | POCATELLO
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State | ID
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Zip | 83204-2901
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Country | US
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Telephone | 360-721-0091
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 5381021
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License Number State | ID
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