Provider Demographics
NPI:1316710429
Name:BARTOSH, ZAYDEN Q (LAC)
Entity type:Individual
Prefix:
First Name:ZAYDEN
Middle Name:Q
Last Name:BARTOSH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:NICHOLE
Other - Last Name:BARTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1308 ELBOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5712
Mailing Address - Country:US
Mailing Address - Phone:701-751-8260
Mailing Address - Fax:701-751-2274
Practice Address - Street 1:1308 ELBOWOOD LN
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5712
Practice Address - Country:US
Practice Address - Phone:701-751-8260
Practice Address - Fax:701-751-2274
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1962101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)