Provider Demographics
NPI:1093502353
Name:VENNING, ZACARRAH
Entity type:Individual
Prefix:
First Name:ZACARRAH
Middle Name:
Last Name:VENNING
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 SPRINGWELL CT
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1947
Mailing Address - Country:US
Mailing Address - Phone:678-314-5142
Mailing Address - Fax:
Practice Address - Street 1:1062 W MERCURY BLVD STE 1062B
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-1068
Practice Address - Country:US
Practice Address - Phone:757-644-0644
Practice Address - Fax:757-819-4581
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty