Provider Demographics
NPI:1154595338
Name:ZARSKE, JOHN ALDEN
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALDEN
Last Name:ZARSKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1303
Mailing Address - Country:US
Mailing Address - Phone:928-607-8129
Mailing Address - Fax:928-774-8405
Practice Address - Street 1:119 E TERRACE AVE STE C
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5267
Practice Address - Country:US
Practice Address - Phone:928-362-1220
Practice Address - Fax:928-774-8405
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ973103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ730029Medicaid
AZ730029Medicaid