Provider Demographics
NPI:1033269261
Name:ZWACK, MARY K (MS, LADC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:ZWACK
Suffix:
Gender:F
Credentials:MS, LADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 ARIEL ST N
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2203
Mailing Address - Country:US
Mailing Address - Phone:651-770-1311
Mailing Address - Fax:651-770-1879
Practice Address - Street 1:2480 WHITE BEAR AVE N STE 101
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5165
Practice Address - Country:US
Practice Address - Phone:651-770-1311
Practice Address - Fax:651-770-1879
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLMFT1368106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist