Provider Demographics
NPI:1154565109
Name:ZINN, ZACHARIAH WILLIAM (SUDP)
Entity type:Individual
Prefix:
First Name:ZACHARIAH
Middle Name:WILLIAM
Last Name:ZINN
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 PARKMONT LN SW
Mailing Address - Street 2:BLDG B, STE, A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1031
Mailing Address - Country:US
Mailing Address - Phone:360-943-2940
Mailing Address - Fax:360-943-5616
Practice Address - Street 1:6005 TYEE DR SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7356
Practice Address - Country:US
Practice Address - Phone:360-464-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2022-10-31
Deactivation Date:2018-02-22
Deactivation Code:
Reactivation Date:2018-06-27
Provider Licenses
StateLicense IDTaxonomies
WAMA60065983225700000X
WACP61012875101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist