Provider Demographics
NPI:1285236992
Name:RUNK, ZACHARY W
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:W
Last Name:RUNK
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 1:7964 LAUREL FLATS DR
Mailing Address - Street 2:
Mailing Address - City:CASEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62232-1216
Mailing Address - Country:US
Mailing Address - Phone:262-339-6121
Mailing Address - Fax:
Practice Address - Street 1:7964 LAUREL FLATS DR
Practice Address - Street 2:
Practice Address - City:CASEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62232-1216
Practice Address - Country:US
Practice Address - Phone:126-233-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician