Provider Demographics
NPI:1336656339
Name:JONES, ZANDRA (CB60799953)
Entity Type:Individual
Prefix:
First Name:ZANDRA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:CB60799953
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 LILLY RD NE STE B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-3091
Mailing Address - Country:US
Mailing Address - Phone:360-456-2237
Mailing Address - Fax:
Practice Address - Street 1:3443 LILLY RD NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-3091
Practice Address - Country:US
Practice Address - Phone:360-456-2237
Practice Address - Fax:360-456-2237
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60799953106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician