Provider Demographics
NPI:1093089591
Name:ZIETZ, DONALD P (AAS-HIS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:ZIETZ
Suffix:
Gender:M
Credentials:AAS-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22525 SE 64TH PL
Mailing Address - Street 2:STE 2030
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5383
Mailing Address - Country:US
Mailing Address - Phone:425-358-0956
Mailing Address - Fax:877-481-6931
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
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00004650237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA332500000XMedicaid