Provider Demographics
NPI:1134128614
Name:ZACHIDNIAK, LOUISE ANNE (LMSW-ACP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:ANNE
Last Name:ZACHIDNIAK
Suffix:
Gender:F
Credentials:LMSW-ACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 KNICKERBOCKER RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-8823
Mailing Address - Country:US
Mailing Address - Phone:325-942-7531
Mailing Address - Fax:325-942-7532
Practice Address - Street 1:3471 KNICKERBOCKER RD
Practice Address - Street 2:SUITE 508
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-8823
Practice Address - Country:US
Practice Address - Phone:325-942-7531
Practice Address - Fax:325-942-7532
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86313QOtherBLUECROSS BLUE SHIELD
TX125397OtherSUPERIOR HEALTHPLAN NET
TX125397OtherSUPERIOR HEALTHPLAN NET