Provider Demographics
NPI:1326457722
Name:ZESTOS, EVA VICKY (LLBSW)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:VICKY
Last Name:ZESTOS
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-1570
Mailing Address - Country:US
Mailing Address - Phone:989-799-0066
Mailing Address - Fax:989-799-6867
Practice Address - Street 1:305 S. NIAGARA
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602
Practice Address - Country:US
Practice Address - Phone:989-799-0066
Practice Address - Fax:989-799-6867
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088245104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker