Provider Demographics
NPI:1043789530
Name:ZOGG, WILLIAM ZANE (MA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ZANE
Last Name:ZOGG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4113 BRIDGEPORT WAY W STE C1
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4325
Mailing Address - Country:US
Mailing Address - Phone:509-290-7809
Mailing Address - Fax:
Practice Address - Street 1:4113 BRIDGEPORT WAY W STE C1
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4325
Practice Address - Country:US
Practice Address - Phone:509-290-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2023-03-21
Deactivation Date:2022-08-29
Deactivation Code:
Reactivation Date:2022-09-23
Provider Licenses
StateLicense IDTaxonomies
WALH61050187101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health