Provider Demographics
NPI:1104418516
Name:ZIEMIANIN, ZACHARY (BS)
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:
Last Name:ZIEMIANIN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 FERN CT
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-3144
Mailing Address - Country:US
Mailing Address - Phone:224-636-0367
Mailing Address - Fax:
Practice Address - Street 1:704 FERN CT
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3144
Practice Address - Country:US
Practice Address - Phone:224-636-0367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILBACB571710106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician