MEDICARE: LASHELLE ZELLNER

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	103T00000X	Psychologist	PSY-004685	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578796850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASHELLE ZELLNER

Provider Business Mailing Address
First Line	:	CMR 402
Second Line	:	BOX 33100
City	:	APO
State	:	AE
Zip	:	09810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	CMR 402
Second Line	:	BOX 33100
City	:	APO
State	:	AE
Zip	:	09810
Country	:	US
Telephone Number	:	314-590-7224
Fax Number	:

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	12/23/2024

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Directions to “ LASHELLE ZELLNER ” Practice Location

Language	Start Address	Practice Location

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