Provider Demographics
NPI:1275962821
Name:ZONDAG, CARRIEANN (MSW, CAPSW)
Entity Type:Individual
Prefix:
First Name:CARRIEANN
Middle Name:
Last Name:ZONDAG
Suffix:
Gender:F
Credentials:MSW, CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 ST ALBERT DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-4433
Mailing Address - Country:US
Mailing Address - Phone:920-373-8996
Mailing Address - Fax:
Practice Address - Street 1:883 ST ALBERT DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-4433
Practice Address - Country:US
Practice Address - Phone:920-373-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI128319-121101Y00000X, 101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker