Provider Demographics
NPI:1679960793
Name:ZAJAC, JOHN J (LADC, LSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:LADC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERHAM
Mailing Address - State:MN
Mailing Address - Zip Code:56573-1934
Mailing Address - Country:US
Mailing Address - Phone:218-346-6100
Mailing Address - Fax:218-346-6112
Practice Address - Street 1:840 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PERHAM
Practice Address - State:MN
Practice Address - Zip Code:56573-1934
Practice Address - Country:US
Practice Address - Phone:218-346-6100
Practice Address - Fax:218-346-6112
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302955101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)