Provider Demographics
NPI:1225497340
Name:ZAZULAK, ELLEN (MS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ZAZULAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9761
Mailing Address - Country:US
Mailing Address - Phone:610-597-1787
Mailing Address - Fax:
Practice Address - Street 1:2173 EMBASSY DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2387
Practice Address - Country:US
Practice Address - Phone:717-431-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist