Provider Demographics
NPI:1053749564
Name:DONALD P. ZIETZ
Entity type:Organization
Organization Name:DONALD P. ZIETZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:ZIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:AAS-HIS
Authorized Official - Phone:360-336-5881
Mailing Address - Street 1:1810 E COLLEGE WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2362
Mailing Address - Country:US
Mailing Address - Phone:360-336-5881
Mailing Address - Fax:360-336-2323
Practice Address - Street 1:1810 E COLLEGE WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2362
Practice Address - Country:US
Practice Address - Phone:360-336-5881
Practice Address - Fax:360-336-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty