MEDICARE: MRS. ALLISON ZEDNICEK MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT01129	NV
2	106H00000X	Marriage & Family Therapist	MFC42281	CA

General Provider Information

NPI Number	:	1427104934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALLISON ZEDNICEK MFT

Provider Business Mailing Address
First Line	:	1080 MARINA VILLAGE PKWY
Second Line	:	STE 100
City	:	ALAMEDA
State	:	CA
Zip	:	94501-6427
Country	:	US
Telephone Number	:	805-478-6556
Fax Number	:	805-758-6914

Provider Business Practice Location Address
First Line	:	1080 MARINA VILLAGE PKWY
Second Line	:	STE 100
City	:	ALAMEDA
State	:	CA
Zip	:	94501-6427
Country	:	US
Telephone Number	:	805-478-6556
Fax Number	:	805-758-6914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	11/08/2011

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