Provider Demographics
NPI:1720363666
Name:ZAJONC, MCKENZIE ANNE (CN)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ANNE
Last Name:ZAJONC
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 WOODLAWN AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7522
Mailing Address - Country:US
Mailing Address - Phone:206-947-1234
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE STE 918
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-3325
Practice Address - Country:US
Practice Address - Phone:206-947-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60243397174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator