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General NPI Number Information
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NPI Number | 1568756302
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Entity Type | Individual
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Provider Name | VIVIANE MARIE ZASTROW LICSW
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Gender | Female
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 02/27/2019
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Provider Practice Location Address
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Address Line | 200 W 98TH ST STE 107
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City | BLOOMINGTON
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State | MN
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Zip | 55420-4858
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Country | US
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Telephone | 612-968-6297
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Fax | 612-435-9842
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Provider Business Mailing Address
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Address Line | 18986 LAKE DR E
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City | CHANHASSEN
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State | MN
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Zip | 55317-9348
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Country | US
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Telephone | 952-401-4869
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Fax | 952-474-3652
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17078
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License Number State | MN
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