Provider Demographics
NPI:1285192047
Name:ITO, ZANA CLARISSA (MA61261063)
Entity Type:Individual
Prefix:
First Name:ZANA
Middle Name:CLARISSA
Last Name:ITO
Suffix:
Gender:F
Credentials:MA61261063
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 N NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-3412
Mailing Address - Country:US
Mailing Address - Phone:509-464-2273
Mailing Address - Fax:
Practice Address - Street 1:9720 N NEVADA ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-3412
Practice Address - Country:US
Practice Address - Phone:509-464-2273
Practice Address - Fax:509-242-1854
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WAMA61261063225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA61261063OtherPRIMARY LICENSE