Provider Demographics
NPI:1528354891
Name:ZAJAC, PAUL J (CCC-SLP)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5347 TALLAPOOSA RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-7937
Mailing Address - Country:US
Mailing Address - Phone:229-460-3765
Mailing Address - Fax:
Practice Address - Street 1:5347 TALLAPOOSA RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-7937
Practice Address - Country:US
Practice Address - Phone:229-460-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist