Provider Demographics
NPI:1275666877
Name:HAZENSON, ZOE (LP)
Entity Type:Individual
Prefix:MS
First Name:ZOE
Middle Name:
Last Name:HAZENSON
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CHESTNUT ST E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5116
Mailing Address - Country:US
Mailing Address - Phone:651-439-7309
Mailing Address - Fax:715-531-1453
Practice Address - Street 1:106 CHESTNUT ST E
Practice Address - Street 2:SUITE 101
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-5116
Practice Address - Country:US
Practice Address - Phone:651-439-7309
Practice Address - Fax:715-531-1453
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4790103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist